Thoracic Air Leakage in the Presentation of Cast Bronchitis

Background: Cast bronchitis is a rare but potentially fatal condition caused by the accumulation of mucus in the bronchial tree usually secondary to infection, inflammation, or vascular stasis. Air leakage is an uncommon presentation of cast bronchitis. We report on three children with cast bronchitis who presented with acute air leakage as the main clinical feature. Method: All three patients underwent bronchoscopic evaluation that led to a diagnosis anti removal of bronchial casts. Results: Pathologic examination of casts from all three patients showed a mucoid substance with eosinophilic infiltration. The outcome for all patients was favorable. Conclusions: Acute respiratory failure presenting with wheezing and thoracic air leakage refractory, to standard asthma therapy should raise suspicion of cast bronchitis, and urgent bronchoscopy should be performed. (CHEST 2009; 136:615-617)