article · Radiology Case Reports
Plastic bronchitis is an uncommon cause of respiratory obstruction in children that can closely mimic severe lung disorders on medical imaging. A case involving a young child presenting with prolonged febrile respiratory distress and complete opacification of the left hemithorax highlights this condition. Initial imaging suggested advanced pulmonary damage or foreign body aspiration. However, flexible bronchoscopy identified large bronchial casts blocking the left bronchial tree. Histopathological analysis confirmed these were acellular mucinous casts, indicative of type II plastic bronchitis. Following the bronchoscopic extraction of the casts, the patient experienced rapid clinical and radiological recovery. Extensive testing revealed no underlying cardiac, lymphatic, infectious, or immunological abnormalities. The case demonstrates that plastic bronchitis is a reversible cause of unilateral white lung, where timely bronchoscopy provides critical diagnostic clarity and therapeutic relief while preventing unwarranted invasive procedures.
Severe lung opacification in young children often leads clinicians to suspect permanent tissue damage or foreign body inhalation. Recognising plastic bronchitis as a potential cause demonstrates that complete lung collapse can be entirely reversible. Prompt deployment of flexible bronchoscopy enables clinicians to rapidly relieve critical airway blockages, establish a clear diagnosis, and spare young patients from unnecessary and invasive medical procedures.
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Plastic bronchitis is a rare cause of airway obstruction in children and may mimic severe pulmonary disease on imaging. We report the case of a 2-year-5-month-old boy admitted with prolonged febrile respiratory distress and complete opacification of the left hemithorax on chest radiography. Chest computed tomography suggested extensive left pulmonary involvement, initially raising concern for advanced postobstructive pulmonary damage and foreign body aspiration. Flexible bronchoscopy subsequently revealed extensive bronchial casts obstructing the left bronchial tree, which were successfully removed. Histopathological examination demonstrated acellular mucinous casts consistent with type II plastic bronchitis. Clinical and radiological improvement was rapid following bronchoscopic extraction, and no underlying cardiac, infectious, immunological, or lymphatic cause was identified. This case highlights plastic bronchitis as a rare but reversible cause of unilateral "white lung" in children and emphasizes the pivotal role of early bronchoscopy in establishing the diagnosis, guiding management, and avoiding unnecessary invasive procedures.
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DOI: 10.1016/j.radcr.2026.07.041
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