Nelson Textbook of Pediatrics 22nd Edition | Rare condition characterized by expectoration of large, branching casts that take the shape of the tracheobronchial tree. Two main types: Type 1 (inflammatory) - fibrin-rich with eosinophils, associated with asthma, atopy, infections (influenza, adenovirus, Mycoplasma). Type 2 (acellular) - mucin-rich, associated with congenital heart disease (Fontan physiology) and lymphatic disorders. Diagnosis: expectoration or bronchoscopic removal of casts. Treatment: airway clearance, fibrinolytics (tPA), mucolytics (N-acetylcysteine), management of underlying condition; for Fontan-associated casts, lymphatic embolization or thoracic duct ligation.
🌐 paeds.online — Pakistan's Pediatric Platform| Type | Associated Conditions | Treatment |
|---|---|---|
| Type 1 (Inflammatory, fibrin-rich) | Asthma, atopy, infection (influenza A, adenovirus, Mycoplasma), sickle cell acute chest | Corticosteroids (systemic/inhaled), azithromycin, leukotriene inhibitors, fibrinolytics (tPA), mucolytics |
| Type 2 (Acellular, mucin-rich) | Congenital heart disease (Fontan physiology), single ventricle | Reduce central venous pressure (sildenafil), lymphatic embolization, thoracic duct ligation, cardiac transplantation |