Minimally Invasive Catheterization Techniques and new Imaging Tools for Treatment of Pediatric Plastic Bronchitis

The results of a retrospective study show that a novel minimally invasive procedure consisting of a Magnetic Resonance (MR) lymphangiogram and lymphatic embolization, can help relieve airway blockages that can occur in children as a result of congenital heart defect surgery.

Pediatric physicians-researchers found that the main cause of plastic bronchitis is abnormal lymphatic flow into lung tissue, which is often undiagnosed. Plastic bronchitis is a rare complication in about 5% of children who survive heart surgery for single-ventricle disease. Abnormal circulation can cause lymph to leak into a child's airways and dry, forming a cast.


To treat this the researchers developed a new imaging technique called dynamic contrast enhanced MR lymphangiogram that enabled them to visualize the anatomy and flow in the lymphatic system, and locate sites where lymph leaks into the airways. After identifying the leakage site in a lymph vessel, the team used lymphatic embolization and iodized oil, coils, or covered stents, based on the specific case, to block the abnormal flow of lymph.

The retrospective study included 18 children with plastic bronchitis at the Children's Hospital of Philadelphia (CHOP; Philadelphia, PA, USA). The researchers published the results of the study online, ahead of print, on February 10, 2016, in the journal Circulation. The team performed lymphatic embolization in 17 patients, aged between two and 15 years, with a median age of 8.6 years. Fifteen patients showed significantly improvements in cast formation, lasting for more than two years in some cases. Transient side effects included abdominal pain and low blood pressure, but the authors reported that the procedure appeared safe in the patients treated.

According to the researchers the treatment has can offer long-term improvement, or even a cure in patients with plastic bronchitis, avoiding the need to perform a heart transplant. The techniques have also been successfully used to treat patients with idiopathic plastic bronchitis that does not have a known cause.

Maxim Itkin, MD, associate Radiology professor, Perelman School of Medicine, University of Pennsylvania, (PENN Medicine; Philadelphia, PA, USA), said, "We have expanded on that study to report short-term outcomes in a larger group, and to share insights into the development of plastic bronchitis, which has been poorly understood.”

Related Links:
Children's Hospital of Philadelphia
Perelman School of Medicine