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Special Feature
Sep 2011

Picture of the Month—Diagnosis

Arch Pediatr Adolesc Med. 2011;165(9):866. doi:10.1001/archpediatrics.2011.141-b

A symmetry was noted in the radiograph, with hyperinflation of the right hemithorax and near-complete opacification on the left. The patient was taken emergently to the operating room for suspected airway foreign body. Bronchoscopic examination revealed an endobronchial cast, which was removed from the left mainstem bronchus (Figure 2). Ventilation of the left lung following removal of the cast revealed a laceration of the left mainstem bronchus (Figure 3). Final pathological analysis of the cast revealed large numbers of eosinophils with mixed cells. Five months after admission, he is doing well with no residual pulmonary deficits.

Plastic bronchitis, also referred to as cast bronchitis, is a rare disease characterized by the formation of mucoid branching impressions of the bronchial tree. These rigid casts can cause obstruction of large and small bronchi at multiple levels and may lead to significant respiratory distress or death.

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