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• W2894776525 abstract "SESSION TITLE: Allergy and Airway SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Bronchial casts are endoluminal obstructions of the tracheobronchial tree. Generally grouped into two categories: inflammatory (underlying pulmonary disease) and hypocellular (congenital heart disease and decreased pulmonary lymphatic drainage)(1), they are uncommon in adults when compared to children2(2). Management can be challenging though various modalities such as bronchodilators, postural drainage and bronchoscopic removal have been described(3). We report 2 cases requiring cryotherapy extraction of bronchial casts. CASE PRESENTATION: Patient 1: A 24-year-old woman with 12-month history of increased cough refractory to multiple courses of oral corticosteroids and antibiotics presented with progressive dyspnea and hypoxemia. She had a history of ARDS secondary to gram-negative sepsis a year and half ago but no prior asthma preceding acute illness. Computed tomography (CT) of chest revealed left lower lobe (LLL) collapse, left upper lobe (LUL) endobronchial obstruction and post-obstructive hyper-expansion of the LUL. Laboratory evaluation revealed elevated serum IgE(276) and total eosinophil count(1200). Bronchoscopy revealed obstruction of the LMS bronchus extending into LLL segments with mucous casts. Cryotherapy extraction followed by therapeutic aspiration of the affected tracheobronchial tree resulted in re-expansion of the lung and improvement in symptoms. Pathologic evaluation of the casts showed numerous eosinophils and Charcot-Leyden crystals consistent with allergic mucus. Bacterial and fungal cultures were negative. She was discharged on an extended oral corticosteroid course and continues to do well with improved symptoms at 2-month follow-up. Patient 2: A 78-year-old woman, former smoker, with history of moderate persistent asthma presented with worsening dyspnea and hypoxemia with exertion. PET-CT imaging of her chest revealed multiple areas of atelectasis and a mild-FDG activity of a right cardiophrenic angle mass. Bronchoscopy revealed mucous casts obstructing the LLL antero-medial, LUL inferior lingua, and right upper lobe anterior segments. Cryotherapy extraction of the casts was performed resulting in significant clinical improvement. Pathology demonstrated degranulated eosinophils and Charcot Leyden crystals consistent with allergic mucus. A.fumigatus antigen was within normal limits. She was discharged home on an extended course of oral corticosteroids. DISCUSSION: Central airway obstruction (CAO) due to bronchial casts has high morbidity in severe Asthmatics. Inspissated casts resulting in bronchiectatic airways are hard to suction and biopsy forceps are inadequate given friability of casts. Cryotherapy is a useful modality in extraction of the casts with flexible bronchoscopy even for distal impaction. CONCLUSIONS: CAO due to bronchial casts is a rare complication of adult asthma. Cryotherapy extraction is effective in complete relief of obstruction. Reference #1: Seear M, Hui H, Magee F, Bohn D, Cutz E. Bronchial casts in children: A proposed classification based on nine cases and a review of the literature. Am J Respir Crit Care Med. 1997. https://doi.org/10.1164/ajrccm.155.1.9001337 Reference #2: Kim EJ, Park JE, Kim DH, Lee J. Plastic bronchitis in an adult with asthma. Tuberc Respir Dis (Seoul). 2012. https://doi.org/10.4046/trd.2012.73.2.122 Reference #3: Kunder R, Kunder C, Sun HY, et al. Pediatric Plastic Bronchitis: Case Report and Retrospective Comparative Analysis of Epidemiology and Pathology. Reports Pulmonol. 2013;8. https://doi.org/10.1155/2013/649365 DISCLOSURES: No relevant relationships by DIVYANSH BAJAJ, source=Web Response No relevant relationships by Or Kalchiem-Dekel, source=Web Response No relevant relationships by Edward Pickering, source=Web Response No relevant relationships by Ashutosh Sachdeva, source=Web Response No relevant relationships by Zachary Strumpf, source=Web Response" @default.
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• W2894776525 date "2018-10-01" @default.
• W2894776525 modified "2023-09-27" @default.
• W2894776525 title "CRYOTHERAPY EXTRACTION OF BRONCHIAL CASTS IN ADULT ASTHMATICS" @default.
• W2894776525 doi "https://doi.org/10.1016/j.chest.2018.08.005" @default.
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