A CASE OF PLASTIC BRONCHITIS POST EBUS-TBNA

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Plastic bronchitis (PB) is a disorder in which intrapulmonary lymphatic overload or leakage causes retrograde thoracic flow into lungs, forming mucofibrinous bronchial casts that can result significant airway obstruction. PB associated with congenital heart disease children; adults, etiology less clear. Presentation expectoration of thick, rubbery secretions histopathology revealing cross-linked branching mucin-containing, lymphocyte-predominant casts. However, without high clinical suspicion, this be confused mucous plugging pneumonia. Here we present case plastic patient after EBUS-TBNA for diagnosing and staging lung nodule. CASE PRESENTATION: A 75-year-old woman history COPD remote breast cancer right mastectomy radiation underwent EBUS FNA middle lobe mass found incidentally on pre-operative chest x-ray. She was diagnosed Stage III squamous cell carcinoma the done stations 4R,7 11Rs. Shortly she developed cough progressed to acute dyspnea, wheezing thick sputum production did not improve course antibiotics prednisone. Chest CT showed atelectasis upper ground-glass opacification interlobular septal thickening lower lobe. Bronchoscopy revealed an obstructive cast bronchus intermedius, extending lobes, removed Cryoprobe. Histopathology material lymphocytes & foamy macrophages consistent Type II cast. IR lymphangiogram proliferation mediastinal channels lobar/interlobar lymphadenopathy. treated percutaneous embolization duct mainstem peribronchial channels, complicated by post-procedure pancreatitis. Symptoms slowly improved aggressive physiotherapy bronchodilators. No were seen repeat bronchoscopy. One month later able discharged begin chemo radiation. DISCUSSION: likely more common than reported most literature has focused pediatric cases. cause life-threatening events 40 percent cases, particularly if mis-diagnosed, causative etiologies adults are fully understood. This patient's lymph node dissection active malignancy may have put her at risk but timing symptoms raise concern itself been trigger development PB. CONCLUSIONS: Our illustrates should considered as complication arise post patients impaired drainage previous treatment. To best our knowledge first EBUS-TBNA. REFERENCE #1: Rubin B. Bronchitis. Clinics Medicine 2016; 37(3):405. #2: Coen M, Daniel L, Serratrice J. An adult bronchitis: rare multifactorial disease. J Thorac Dis. 2018;10(1):E16-E19. #3: Madsen P, Shah SA, BK. new insights classification scheme. Paediatr Respir Rev 2005;6:292-300. DISCLOSURES: relevant relationships Edward Adams, source=Web Response Abduljabbar Dheyab, Shaun Toomey,