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Plastic bronchitis — RACP Paediatrics MCQ

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HardCardiologyPlastic bronchitisRACP Paediatrics

An 8-year-old with a Fontan circulation develops recurrent cough productive of thick mucoid bronchial casts. Flexible bronchoscopy retrieves branching gelatinous material from the airways. What is the most likely complication?

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Correct answer: D — Plastic bronchitis

Plastic bronchitis is a rare but serious Fontan complication involving formation of large branching casts in the airways from lymphatic leak. The casts can cause life-threatening airway obstruction. Treatment options include inhaled tPA, bronchoscopic cast removal, thoracic duct ligation, and lymphatic interventions. It reflects abnormal lymphatic dynamics in the Fontan circulation.

Reference: RCH Melbourne – 2023 – Fontan CPG; RACP Paediatric Curriculum – Cardiology