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CASE REPORT article

Front. Pediatr.

Sec. Pediatric Cardiology

Case Series : Clinical Challenges in Pediatric Plastic Bronchitis

Provisionally accepted
Nouf Nasser AlbalawiNouf Nasser Albalawi1,2,3*Dina alafandiDina alafandi1,2,3ahmad Alessaahmad Alessa4Ali alqahtaniAli alqahtani2,3,5yousef alshehriyousef alshehri1,3,5haitham almoffarrehhaitham almoffarreh6Ziyad AlkathiriZiyad Alkathiri7
  • 1King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
  • 2Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
  • 3King Abdulaziz Medical City in Riyadh, Riyadh, Saudi Arabia
  • 4King Abdullah Medical City, Mecca, Saudi Arabia
  • 5King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
  • 6Dr Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia
  • 7King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

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Abstract: Background: Plastic bronchitis (PB), or bronchial cast syndrome, is a rare but serious complication predominantly seen in children with congenital heart disease, particularly following Fontan-type surgeries. The disorder is marked by the development of cohesive bronchial casts that may result in life-threatening obstruction of the airways. Methods: We present a series of three pediatric cases with complex congenital heart disease who developed plastic bronchitis after Fontan-style palliative surgery. We detail their clinical presentation, diagnostic workup, management, and outcomes. Results: All three patients presented with acute respiratory symptoms and expectoration of bronchial casts. Each had undergone multiple prior cardiac surgeries, culminating in a Fontan-type procedure. Management focused on symptomatic relief, supportive care, and in some cases, bronchoscopy cast removal. Variable clinical courses and outcomes highlight the challenges in diagnosis and management. Conclusion: Plastic bronchitis in children with congenital heart disease necessitates high clinical suspicion and a multidisciplinary approach for prompt intervention. Further research is required to improve outcomes in this vulnerable population.

Keywords: Bronchial cast, congenital heart disease, Fontan Procedure, pediatric, Plastic bronchitis

Received: 02 Oct 2025; Accepted: 10 Feb 2026.

Copyright: © 2026 Albalawi, alafandi, Alessa, alqahtani, alshehri, almoffarreh and Alkathiri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Nouf Nasser Albalawi

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material