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Most patients who present with expectoration of complex, branching casts do not have idiopathic plastic bronchitis, but have abnormal pulmonary lymphatic flow that is associated with abnormal communications with the airspace. We propose the diagnosis lymphatic plastic bronchitis to differentiate this disorder from those of unknown cause. One patient in our series did not have an identifiable lymphatic etiology for his symptoms, and the diagnosis of idiopathic plastic bronchitis is appropriate for that subject.In patients with suspected lymphatic plastic bronchitis, DCMRL and intranodal lymphangiography may reveal abnormal lymphatic flow and the site of communication of the lymphatics with the airways, which can be useful for planning interventional strategies.
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