Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


New treatment resolves a hazardous airway complication in child with heart disease


Innovative treatment of child with plastic bronchitis heralds unique program in lymphatic interventions by CHOP, Penn experts

A case study published recently in the journal Pediatrics describes an innovative, minimally invasive procedure that treated plastic bronchitis, a potentially life-threatening disease, in a six-year-old boy with a heart condition. Using new lymphatic imaging tools and catheterization techniques, physician-researchers eliminated bronchial casts, which are an accumulation of lymphatic material that clogged the child's airway.

Jameson Finley of McKinney, Tex., is the 6-year-old boy who successfully received innovative treatment at CHOP for plastic bronchitis that was clogging his airway.

Credit: The Children's Hospital of Philadelphia

"Our technique represents a new treatment option for plastic bronchitis, which is a rare but often fatal complication of pediatric surgery for single-ventricle disease," said

Yoav Dori, M.D., Ph.D., a pediatric cardiologist in the Cardiac Center at The Children's Hospital of Philadelphia (CHOP), who is the co-author and part of a specialized team which included interventional radiologist Maxim Itkin, M.D., of the Perelman School of Medicine at the University of Pennsylvania, and Marc S. Keller, M.D., an interventional radiologist at CHOP.

Plastic bronchitis is a lymphatic flow disorder, one of a group of diseases characterized by abnormal circulation of lymph, a fluid with a crucial role in immune function and fat and protein transport. Because it has traditionally been difficult to obtain clear images of the lymphatic system, lymphatic flow disorders have often gone undiagnosed. CHOP and Penn are de facto world leaders in lymphatic interventions in children and adults.

The child in the case study, like others with plastic bronchitis, underwent a series of early-childhood heart surgeries, leading to the Fontan procedure, for the birth defect hypoplastic left heart syndrome (HLHS). In HLHS, the left ventricle, one of the heart's pumping chambers, is severely underdeveloped. Some 5 to 10 percent of patients experience plastic bronchitis as a consequence of altered venous and lymphatic pressure resulting from Fontan surgery.

The abnormal circulation causes lymph to ooze into a patient's airways, drying into a fibrous, caulk-like cast formation that takes the shape of the airways. If a child is unable to cough out the cast, the blockage may cause fatal asphyxiation.

In the case study published today, a 6-year-old boy with HLHS had undergone Fontan surgery three years previously. At age five and a half, he suffered respiratory distress and was admitted to a community hospital. Over the next several months, despite a series of evaluations and drug treatments, he continued to have frequent casts.

The boy was referred to CHOP for further evaluation. There the care team used specially developed magnetic resonance imaging (MRI) to visualize the anatomy and flow pattern of lymph in the patient's body, and pinpointed the leakage site: a network of dilated lymphatic vessels surrounding the airway and connected to the thoracic duct through a dilated lymphatic channel. Dori, Itkin and Keller performed the MRI lymphatic techniques they have developed for these children, including dynamic contrast enhanced MRI lymphangiography which provides clearer images of the anatomy and flow of the lymphatic system than conventional MRI.

"Our image analysis allowed us to plan the intervention," said Dori. The team decided on a technique called selective lymphatic embolization. Working in CHOP's interventional cardiac catheterization suite, they injected iodized oil into the leaky small vessel lymphatic network and then glued shut the abnormal dilated feeder lymphatic duct. Stemming the abnormal flow resolved the child's plastic bronchitis. "Eleven months after the procedure, the patient remained free of symptoms, was able to discontinue taking respiratory medicines, and is now playing on a soccer team" said Itkin. Although further investigation must be done in other patients, the authors conclude that selective lymphatic embolization is a potential new treatment for plastic bronchitis. Its targeted, noninvasive application to only the affected site may offer better outcomes for patients.

In fact, "It is conceivable that this technique could even result in a long-term cure for plastic bronchitis," said co-author Jack Rychik, M.D., director of CHOP's Single Ventricle Survivorship Program. "Characterization of the lymphatic system and therapeutic lymphatic intervention may play an important role as we strive to better understand the circulatory consequences of the Fontan operation, in particular those seen in plastic bronchitis" says Rychik. A multi-disciplinary approach involving teams of experts in single ventricle, cardiac catheterization and interventional radiology all focused on the challenges these patients face, as witnessed in this report, is essential for the development of successful outcomes.

CHOP and Penn to Launch Program in Lymphatic Interventions

Plastic bronchitis is one of several lymphatic flow disorders affecting children and adults. Building on their research and clinical expertise in this area, CHOP and Penn Medicine are jointly launching the Lymphatic Imaging and Interventions Program. Among the conditions it will address are chylopericardium and chylothorax, resulting from the leakage of lymphatic fluid into the sac around the heart and into the thoracic cavity, respectively. A similar condition, chylous ascites, occurs when the fluid leaks into the peritoneal cavity.

The center will treat other disorders of lymphatic flow due to diseases such as lymphoangiomatosis, Gorham's disease and lymphangioleiomyomatosis. In addition to plastic bronchitis, some Fontan patients develop another serious lymphatic complication called protein-losing enteropathy that results in leakage of lymphatic fluid and protein into the intestine.

Most of these disorders are individually very rare, so patients requiring this highly specialized care will have access to a dedicated program with clinicians who are world leaders in managing these diseases.


For more information on the Lymphatic Imaging and Intervention Program, visit

Dori et al, "Successful Treatment of Plastic Bronchitis by Selective Lymphatic Sclerosis in a Fontan Patient," August 2014 Pediatrics

About The Children's Hospital of Philadelphia

The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program receives the highest amount of National Institutes of Health funding among all U.S. children's hospitals. In addition, its unique family-centered care and public service programs have brought the 535-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit

Joey McCool Ryan | Eurek Alert!

Further reports about: CHOP HLHS MRI Philadelphia airway diseases disorders hazardous heart disease lymph lymphatic lymphatic system plastic

More articles from Health and Medicine:

nachricht Resolving the mystery of preeclampsia
21.10.2016 | Universitätsklinikum Magdeburg

nachricht New potential cancer treatment using microwaves to target deep tumors
12.10.2016 | University of Texas at Arlington

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

Im Focus: New Products - Highlights of COMPAMED 2016

COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.

In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...

Im Focus: Ultra-thin ferroelectric material for next-generation electronics

'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.

Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Resolving the mystery of preeclampsia

21.10.2016 | Health and Medicine

Stanford researchers create new special-purpose computer that may someday save us billions

21.10.2016 | Information Technology

From ancient fossils to future cars

21.10.2016 | Materials Sciences

More VideoLinks >>>