Thoracic lymphatic embolization as treatment of plastic bronchitis associated with congenital heart disease

Introduction: Plastic bronchitis is a severe complication of children with congenital heart disease. Retrograde lymphatic flow from the thoracic duct toward lung parenchyma is believed to play a role in the formation of bronchial casts, and interruption of this abnormal lymphatic flow has been shown as an effective treatment in these patients. Case report: This is a case report of a patient diagnosed of Tetralogy of Fallot, who initially underwent a right Blalock-Taussig shunt and, when he was 1 year old, a surgical correction requiring re-do pulmonary artery reconstruction at 4 and 9 years. At the age of 10 years old, he started to explain sudden cough attacks with mucous plugs expectoration as well as severe dyspneic episodes, some of them requiring an emergency broncoscopy to remove bronchial casts. Having been treated with several medications without a definite healing, ten years later he underwent both a thoracic MRI with contrast infusion and a lymphography which confirmed bilateral hilar and peribronchial extravasation of the contrast, with dilated abnormal lymphatic mediastinal vessels. These findings suggested a retrograde pulmonary lymphatic flow possibly due to interruption of the thoracic duct. After the diagnostic procedures, a percutaneous embolization with glue of the abnormal lymphatic ducts was performed. Following this treatment, the patient had a significant improvement in his symptoms since he had no more episodes of bronchial plugs. Conclusion: In this case report, we demonstrated an aberrant thoracic lymphatic flow in a patient with a life-threatening condition such as plastic bronchitis after cardiac surgery, whose symptoms were amended with a novel technique.