Am. J. Respir. Crit. Care Med., Vol 155, No. 1, 01 1997, 364-370.
Bronchial casts in children: a proposed classification based on nine cases and a review of the literature
M Seear, H Hui, F Magee, D Bohn and E Cutz
Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada.
Bronchial casts are characterized by the formation of obstructive airway
plugs that may be large enough to fill the branching pattern of an entire
lung. The condition is rare but can occur at any age. Casts may be
secondary to underlying diseases such as asthma and cystic fibrosis, but
there are often no predisposing factors. There is no accepted
classification system for bronchial casts; but only a confusion of
descriptive terms such as mucoid impaction, fibrinous bronchitis, and
pseudomembranous bronchitis. Based on a review of nine well-documented
cases and the available literature, we have separated bronchial casts into
two well-defined groups: Type 1 (inflammatory), consisting of casts
composed mainly of fibrin with a dense eosinophilic inflammatory
infiltrate; and Type 2 (acellular), consisting of casts composed mainly of
mucin with little or no cellular infiltrate and occurring only in children
with congenital cyanotic heart disease. Acute mortality was high in both
groups. Survivors of Type 1 casts seem to be well controlled with inhaled
steroids. Optimal therapy for patients with Type 2 casts is not clear; the
prognosis probably depends on underlying cardiac status. We hope that this
simple classification will provide a framework for further study of this
obscure condition.
