Correspondence

Bronchial Cast

N Engl J Med 2002; 347:696August 29, 2002

Article

To the Editor:

The Image in Clinical Medicine entitled “Bronchial Cast” (March 28 issue)1 describes a patient who had had respiratory symptoms for six months and who expectorated a bronchial cast. However, the authors do not mention the outcome. Was the patient cured after coughing up this rather large cast? Most physicians are still interested in answers to such questions.

Douglas R. Migden, D.O., J.D.
Virginia Mason Medical Center, Seattle, WA 98111
drmigden@aol.com

1 References

1. 1

   Studer SM, Terry PB. Bronchial cast. N Engl J Med 2002;346:981-981
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: The differential diagnosis of cough productive of bronchial casts is considerable,1 and such coughs are often associated with pulmonary disease that may be characterized by hypersecretion of mucus. Treatment of the underlying pulmonary disease may decrease the formation of bronchial casts, but as was the case with our patient, a primary lung disease cannot always be identified. This condition of idiopathic bronchial cast formation has been termed plastic, or fibrinous, bronchitis.2 Proposed treatments for plastic bronchitis include bronchodilators, antibiotics for bacterial infection, hydration, chest physiotherapy, postural drainage,3 and bronchoscopic removal of casts.4

Our patient received inhaled bronchodilators for several weeks, with no change in bronchial casts. Administration of oral corticosteroids resulted in a slight decrease in cast formation. Antibiotics were not prescribed, since there was no evidence of bacterial infection, and DNase was considered but not used because histopathological examination revealed that the cast was relatively acellular in nature. Our patient moved out of the area and was lost to follow-up several months after his initial presentation, but published reports suggest that he may have periods of remission lasting months or years.3

Sean M. Studer, M.D.
Mount Sinai Medical Center, New York, NY 10029
sean.studer@msnyuhealth.org

Peter B. Terry, M.D.
Johns Hopkins University, Baltimore, MD 21287

4 References

1. 1

   Kao NL, Richmond GW. Cough productive of casts. Ann Allergy Asthma Immunol 1996;76:231-233
   CrossRef | Web of Science | Medline

2. 2

   Bettman M. Report of a case of fibrinous bronchitis, with a review of all cases in the literature. Am J Med Sci 1902;123:304-329
   CrossRef

3. 3

   Jett JR, Tazelaar HD, Keim LW, Ingrassia TS III. Plastic bronchitis: an old disease revisited. Mayo Clin Proc 1991;66:305-311
   Web of Science | Medline

4. 4

   Liston SL, Porto D, Siegel LG. Plastic bronchitis. Laryngoscope 1986;96:1347-1351
   Web of Science | Medline