Cast bronchitis in infants and children
A. Perez-Soler
Department of Pediatrics, Universidad Autonoma, Barcelona, Spain.
Seventy-two children (age range, 3 months to 5.5 years) with a clinical
diagnosis of obstructive bronchitis (asthmatoid or spastic bronchitis or
bronchiolitis) were found to have bronchial casts in the gastric fluid, and
in 2 additional cases casts were spontaneously expectorated in the
bronchial exudate. Cast bronchitis had a long-term course of 10 to 24
months in 65 of the 74 patients. Common radiologic findings included
bronchi presumably filled with secretions, areas of atelectasis, and lung
emphysema of varying degrees. Cast bronchitis did not appear to be
associated with eosinophilia and elevated serum IgE levels. Therefore, an
extrinsic allergic mechanism is not likely involved in the pathogenesis of
the condition. Bronchial casts had varying consistencies; although they
were usually soft, they were sometimes rather hard. They were hollow, often
ramified, and white and measured from 0.5 to 2 cm in length.
Histologically, they consisted of metaplastic squamous epithelium with a
varying degree of inflammatory cells and noncellular material. Some
differences in biochemical composition were observed between bronchial
casts and bronchial exudate of acute catarrhal bronchitis. No viruses could
be isolated in 11 cast specimens. Our results suggest that cast formation
is mainly related to the metaplastic transformation of the bronchial
epithelium and that this metaplasia may play an important pathophysiologic
role in certain infants and children with obstructive bronchitis.
