Successful treatment of plastic bronchitis by selective lymphatic embolization in a Fontan patient.
Plastic bronchitis is a rare and often fatal complication of single-ventricle surgical palliation after total cavopulmonary connection. Although lymphatic abnormalities have been postulated to play a role in the disease process, the etiology and pathophysiology of this complication remain incompletely understood. Here we report on the etiology of plastic bronchitis in a child with total cavopulmonary connection as demonstrated by magnetic resonance (MR) lymphangiography. We also report on a new treatment of this disease. The patient underwent noncontrast T2-weighted MR lymphatic mapping and dynamic contrast MR lymphangiography with bi-inguinal intranodal contrast injection to determine the anatomy and flow pattern of lymph in his central lymphatic system. The MRI scan demonstrated the presence of a dilated right-sided peribronchial lymphatic network supplied by retrograde lymphatic flow through a large collateral lymphatic vessel originating from the thoracic duct. After careful analysis of the MRI scans we performed selective lymphatic embolization of the pathologic lymphatic network and supplying vessel. This provided resolution of plastic bronchitis for this patient. Five months after the procedure, the patient remains asymptomatic off respiratory medications.
['Dori|Yoav|Y|', 'Keller|Marc S|MS|', 'Rychik|Jack|J|', 'Itkin|Maxim|M|']
D001991:Bronchitis D002648:Child D004108:Dilatation, Pathologic D004621:Embolization, Therapeutic D018729:Fontan Procedure D006801:Humans D018636:Hypoplastic Left Heart Syndrome D008208:Lymphatic System D042601:Lymphatic Vessels D008220:Lymphography D008279:Magnetic Resonance Imaging D008297:Male D011183:Postoperative Complications D013897:Thoracic Duct
plastic bronchitis lymphatics Fontan single ventricle