What is plastic bronchitis?

Plastic bronchitis is a lymphatic flow disorder that causes severe respiratory issues. In children with plastic bronchitis, lymph fluid builds in the airways and forms rubbery or caulk-like plugs (known as casts). These casts block the airways, making it difficult to breathe.

Lymphatic flow disorders refer to a group of diseases characterized by abnormal circulation of lymph fluid. Lymph vessels carry lymph fluid to veins, where it returns to the bloodstream, playing a crucial role in immune function and fat and protein transport.

Injury to the thoracic duct (the main lymph vessel), congenital abnormalities, or excessively high venous pressures can result in lymphatic flow problems and leakage of lymphatic fluid into the chest, abdomen or other body cavities. In plastic bronchitis, the abnormal circulation causes lymph to leak into the airways.

Treatment for plastic bronchitis

Plastic bronchitis is treated by a team of experts that specialize in lymphatic imaging and interventions. At Children's Hospital of Philadelphia (CHOP), patients have access to a specialized Center for Lymphatic Imaging and Interventions. Treatment depends on the exact cause and the patient’s anatomy.

In all patients, the first step involves careful mapping of the anatomy and flow of the lymphatic system. This is done using a specialized MRI technique called dynamic contrast MR lymphangiography. During this procedure, an MRI contrast agent is injected directly into the lymphatic system.

After the MRI procedure, a small catheter is placed into the main lymphatic channel, called the thoracic duct, to further outline the abnormal ducts that are surrounding the airway.

After the abnormal ducts are identified, they are sealed using a procedure called selective lymphatic duct embolization. Your or your child’s doctor will use oil, coils, particles, glue or other bonding agents, inserted through a tiny tube (catheter), to seal the ducts.

With this procedure, they are careful not to block the main thoracic duct if possible, an approach that experts at CHOP believe is important for the success of this procedure. Because lymphangiography allows clinicians to pinpoint the exact spot of the leak, they can target their intervention to the affected area, preserving the thoracic duct.

The treatment of plastic bronchitis in patients with heart disease may also include cardiac interventional procedures such as balloon dilation, stent dilation of a narrow vessel, or embolization of an abnormal blood vessel with coils.

Your child may also be prescribed medications that can reduce inflammation, lower venous pressures or dissolve the casts.