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Case Reports in Pulmonology
Volume 2013, Article ID 649365, 8 pages
Case Report

Pediatric Plastic Bronchitis: Case Report and Retrospective Comparative Analysis of Epidemiology and Pathology

1Departments of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
2Departments of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
3Departments of Otolaryngology, Head & Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA

Received 25 February 2013; Accepted 24 March 2013

Academic Editors: F. J. Aspa, T. A. Chiang, H. Matsuoka, F. Midulla, and H. Niwa

Copyright © 2013 Rebecca Kunder et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Plastic bronchitis (PB) is a pathologic condition in which airway casts develop in the tracheobronchial tree causing airway obstruction. There is no standard treatment strategy for this uncommon condition. We report an index patient treated using an emerging multimodal strategy of directly instilled and inhaled tissue plasminogen activator (t-PA) as well as 13 other cases of PB at our institution between 2000 and 2012. The majority of cases ( ) occurred in patients with congenital heart disease. Clinical presentations, treatments used, histopathology of the casts, and patient outcomes are reviewed. Further discussion is focused on the epidemiology of plastic bronchitis and a systematic approach to the histologic classification of casts. Comorbid conditions identified in this study included congenital heart disease (8), pneumonia (3), and asthma (2). Our institutional prevalence rate was 6.8 per 100,000 patients, and our case fatality rate was 7%.