Bronchoscopic and histologic findings during lymphatic intervention for plastic bronchitis

Alexandra T. Geanacopoulos, Jill J. Savla, Jennifer Pogoriler, Joseph Piccione, Pelton Phinizy, Aaron G. DeWitt, Joshua J. Blinder, Erin Pinto, Maxim Itkin, Yoav Dori, Samuel B. Goldfarb

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Percutaneous lymphatic intervention (PCL) is a promising new therapy for plastic bronchitis (PB). We characterized bronchoalveolar lavage (BAL) and cast morphology in surgically repaired congenital heart disease (CHD) patients with PB during PCL. We quantified respiratory and bronchoscopic characteristics and correlated them with post-intervention respiratory outcomes. Methods: We retrospectively reviewed patients with PB and surgically repaired CHD undergoing PCL and bronchoscopy at our institution. Pre-intervention characteristics, bronchoscopy notes, BAL cell counts, virology, and cultures were collected. A pathologist blinded to clinical data reviewed cast specimens. Respiratory outcomes were evaluated through standardized telephone questionnaire. Results: Sixty-two patients were included with a median follow-up of 20 months. No patients experienced airway bleeding, obstruction, or prolonged intubation related to bronchoscopy. Of BAL infectious studies, the positive results were 4 (8%) fungal, 6 (11%) bacterial, and 6 (14%) viral. Median BAL count per 100 cells for neutrophils, lymphocytes, and eosinophils were 13, 10, and 0, respectively. Of 23 bronchial casts analyzed, all contained lymphocytes, and 19 (83%) were proteinaceous, with 14 containing neutrophils and/or eosinophils. Median BAL neutrophil count was greater in patients with proteinaceous neutrophilic or eosinophilic casts compared to casts without neutrophils or lymphocytes (P = 0.030). Post-intervention, there was a significant reduction in respiratory medications and support and casting frequency. Conclusions: The predominance of neutrophilic proteinaceous casts and high percentage of positive BAL infectious studies support short-term fibrinolytic and anti-infective therapies in PB in select patients. Flexible bronchoscopy enables safe assessment of cast burden. PCL effectively treats PB and reduces respiratory therapies.

Original languageEnglish (US)
Pages (from-to)1574-1581
Number of pages8
JournalPediatric pulmonology
Volume53
Issue number11
DOIs
StatePublished - Nov 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.

Keywords

  • bronchial casts
  • bronchoalveolar lavage
  • cast frequency
  • cast pathology
  • Fontan physiology
  • percutaneous lymphatic intervention
  • surgically repaired congenital heart disease
  • thoracic duct embolization

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