Lymphatic Vessel Embolization in a Case of Plastic Bronchitis in a Patient with Ebstein´s Anomaly: Therapeutic Resolution of a Complex Case

Abstract

Introduction: Plastic bronchitis is a rare condition characterized by the formation and expectoration of bronchial casts composed of fibrin, glycoproteins, and cellular debris, which can obstruct the airways and cause recurrent atelectasis. Although most frequently associated with chronic pulmonary diseases, it has also been described in patients with congenital heart disease, particularly after corrective surgery that disrupts lymphatic drainage, such as Ebstein’s anomaly. Recent advances have introduced lymphatic embolization as a promising interventional therapeutic alternative.

Case presentation: A 36-year-old woman with chronic heart failure (NYHA III) and Ebstein’s anomaly surgically corrected during childhood presented with productive cough, dyspnea, orthopnea, occasional hemoptysis, and expectoration of bronchial casts. On admission, oxygen saturation was 75%, and chest radiography revealed complete left lung atelectasis. Two bronchoscopies were performed for cast removal, and biochemical analysis confirmed plastic bronchitis. Due to persistent atelectasis, intrapulmonary percussive ventilation was initiated as an airway clearance technique. Lymphangiography demonstrated lymphatic leakage into the left bronchial tree, and selective lymphatic vessel embolization was performed, resulting in complete clinical resolution without recurrence of casts.

Discussion and conclusion: Plastic bronchitis in patients with congenital heart disease may arise from lymphatic alterations secondary to prior cardiac surgery. Lymphatic embolization is an effective and minimally invasive therapeutic strategy, positioning itself as an innovative alternative in refractory cases. This case highlights the value of a multidisciplinary approach and supports embolization as a relevant intervention capable of modifying the clinical course of this complex disorder.