{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:05:00Z","timestamp":1777863900745,"version":"3.51.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fibrinous bronchitis, also known as plastic bronchitis, is a rare airway disorder characterized by branching bronchial casts that replicate the architecture of the bronchial tree. Adult cases are uncommon and frequently misdiagnosed because clinical manifestations and imaging findings are nonspecific. Diagnosis is particularly challenging in the absence of bronchoscopic or histologic confirmation of casts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present a 52-year-old man with a 2-year history of recurrent cough and expectoration of branching mucoid casts. Serial chest imaging showed fluctuating infiltrates without bronchiectasis. Bronchoscopy did not identify casts, presumably because the procedure was performed outside the active expectoration phase. Microbiologic findings were intermittent and not associated with sustained response to antimicrobial therapy. Transbronchial biopsy demonstrated chronic mucosal inflammation with fibrinous exudation, consistent with a fibrin-predominant airway process. Radionuclide lymphoscintigraphy and direct lymphangiography showed mediastinal lymphatic dilatation and pulmonary lymphatic reflux. Based on a convergent evidence framework, a probable diagnosis of fibrinous bronchitis was made. This was based on reproducible cast morphology, supported by indirect histopathologic findings, objective lymphatic abnormalities, and the mismatch between symptoms and treatment response. The patient remained asymptomatic with no recurrence at 8 months following targeted lymphatic embolization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic challenge of adult fibrinous bronchitis in the absence of direct bronchoscopic or histologic confirmation of casts. It suggests that reproducible morphologic features, when interpreted alongside supportive histologic findings and mechanism-oriented imaging, can provide a practical basis for diagnosis. Recognition of symptom\u2013treatment discordance may further prompt reconsideration of non-infectious mechanisms, including lymphatic dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the absence of direct confirmation, a probable diagnosis of fibrinous bronchitis can be supported by converging evidence. Reproducible morphologic patterns, integrated with mechanism-oriented imaging, offer a practical basis for diagnosis and management in rare airway diseases and may facilitate earlier recognition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1825038","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:33:00Z","timestamp":1777527180000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Adult fibrinous bronchitis associated with lymphatic reflux: a probable diagnosis based on convergent evidence"],"prefix":"10.3389","volume":"13","author":[{"given":"Huiwen","family":"Li","sequence":"first","affiliation":[{"name":"College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Duan","sequence":"additional","affiliation":[{"name":"Medical Affairs Department, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjian","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengsen","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxia","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan","place":["Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","first-page":"V03220222","article-title":"[Plastic bronchitis].","volume":"184","author":"Thorup","year":"2022","journal-title":"Ugeskr Laeger."},{"key":"B2","doi-asserted-by":"publisher","first-page":"4001","DOI":"10.2147\/IDR.S405444","article-title":"Outcomes and risk factor analysis of plastic bronchitis Among 321 Children with influenza pneumonia after bronchoscopy examination.","volume":"16","author":"Hu","year":"2023","journal-title":"Infect Drug Resis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1007\/s00246-012-0235-6","article-title":"Plastic bronchitis developing 5 years after Fontan procedure in a girl with Kartagener\u2019s syndrome.","volume":"33","author":"Nawa","year":"2012","journal-title":"Pediatric Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1002\/phar.1290","article-title":"Pharmacotherapy challenges of Fontan-associated plastic bronchitis: a rare pediatric disease.","volume":"33","author":"Brooks","year":"2013","journal-title":"Pharmacotherapy."},{"key":"B5","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1164\/ajrccm.155.1.9001337","article-title":"Bronchial casts in children: a proposed classification based on nine cases and a review of the literature.","volume":"155","author":"Seear","year":"1997","journal-title":"Am J Respir Crit Care Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e70063","DOI":"10.1002\/rcr2.70063","article-title":"Plastic bronchitis in an adult.","volume":"12","author":"Bandara","year":"2024","journal-title":"Respirol Case Rep."},{"key":"B7","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.21037\/jtd.2017.12.02","article-title":"An adult case of plastic bronchitis: a rare and multifactorial disease.","volume":"10","author":"Coen","year":"2018","journal-title":"J Thorac Dis."},{"key":"B8","first-page":"V06210530","article-title":"[Diagnostic bias].","volume":"184","author":"Graff","year":"2022","journal-title":"Ugeskr Laeger."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1513\/AnnalsATS.201604-292OC","article-title":"Diagnosis and treatment of lymphatic plastic bronchitis in adults using advanced lymphatic imaging and percutaneous embolization.","volume":"13","author":"Itkin","year":"2016","journal-title":"Ann Am Thorac Soc."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1161\/CIRCULATIONAHA.115.019710","article-title":"Percutaneous lymphatic embolization of abnormal pulmonary lymphatic flow as treatment of plastic bronchitis in patients with congenital heart disease.","volume":"133","author":"Dori","year":"2016","journal-title":"Circulation."},{"key":"B11","doi-asserted-by":"publisher","first-page":"110627","DOI":"10.1016\/j.clinimag.2025.110627","article-title":"Imaging of central lymphatics in children with Both Trisomy 21 and congenital heart disease.","volume":"127","author":"El Omeiri","year":"2025","journal-title":"Clin Imaging."},{"key":"B12","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1101\/gr.238170.118","article-title":"Laboratory validation of a clinical metagenomic sequencing assay for pathogen detection in cerebrospinal fluid.","volume":"29","author":"Miller","year":"2019","journal-title":"Genome Res."},{"key":"B13","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1146\/annurev-pathmechdis-012418-012751","article-title":"Clinical metagenomic next-generation sequencing for pathogen detection.","volume":"14","author":"Gu","year":"2019","journal-title":"Ann Rev Pathol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"e210048","DOI":"10.1148\/ryct.210048","article-title":"CT features of lymphatic plastic bronchitis in adults: correlation with multimodality lymphatic imaging.","volume":"4","author":"O\u2019Leary","year":"2022","journal-title":"Radiol Cardiothoracic Imaging."},{"key":"B15","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1186\/s12880-024-01504-0","article-title":"Lymphatic plastic bronchitis: a study based on CT and MR lymphangiography.","volume":"24","author":"Hao","year":"2024","journal-title":"BMC Med Imaging."},{"key":"B16","first-page":"363","article-title":"Plastic bronchitis in adult and pediatric patients: a review of its presentation, diagnosis, and treatment.","volume":"118","author":"Patel","year":"2021","journal-title":"Missouri Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"122","DOI":"10.4046\/trd.2012.73.2.122","article-title":"Plastic bronchitis in an adult with asthma.","volume":"73","author":"Kim","year":"2012","journal-title":"Tuberculosis Respir Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.1007\/s00247-022-05449-w","article-title":"Lymphatic anomalies in congenital heart disease.","volume":"52","author":"Ramirez-Suarez","year":"2022","journal-title":"Pediatric Radiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.atssr.2024.02.011","article-title":"Adult plastic bronchitis: a rare cause for chronic productive cough.","volume":"2","author":"Lopez","year":"2024","journal-title":"Ann Thoracic Surg Short Rep."},{"key":"B20","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1002\/ppul.21063","article-title":"Plastic bronchitis as an unusual cause of mucus plugging in cystic fibrosis.","volume":"44","author":"Mateos-Corral","year":"2009","journal-title":"Pediatr Pulmonol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1164\/rccm.202507-1692ST","article-title":"Diagnosis and management of community-acquired pneumonia: an official american thoracic society clinical practice guideline.","volume":"212","author":"Jones","year":"2026","journal-title":"Am J Respir Crit Care Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.prrv.2005.09.001","article-title":"Plastic bronchitis: new insights and a classification scheme.","volume":"6","author":"Madsen","year":"2005","journal-title":"Paediatric Respir Rev."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3023","DOI":"10.1002\/ppul.26650","article-title":"Eosinophilic plastic bronchitis: case series and review of the literature.","volume":"58","author":"Gipsman","year":"2023","journal-title":"Pediatr Pulmonol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e446","DOI":"10.1542\/peds.2011-2883","article-title":"Management of plastic bronchitis with topical tissue-type plasminogen activator.","volume":"130","author":"Gibb","year":"2012","journal-title":"Pediatrics."},{"key":"B25","doi-asserted-by":"publisher","first-page":"210096","DOI":"10.1183\/16000617.0096-2021","article-title":"Recycling plastic: diagnosis and management of plastic bronchitis among adults.","volume":"30","author":"Ntiamoah","year":"2021","journal-title":"Eur Respir Rev."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1002\/ppul.24161","article-title":"Bronchoscopic and histologic findings during lymphatic intervention for plastic bronchitis.","volume":"53","author":"Geanacopoulos","year":"2018","journal-title":"Pediatr Pulmonol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1002\/ppul.10179","article-title":"Plastic bronchitis in children: a case series and review of the medical literature.","volume":"34","author":"Brogan","year":"2002","journal-title":"Pediatr Pulmonol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/MAJ.0b013e318068b60e","article-title":"Plastic bronchitis: a management challenge.","volume":"335","author":"Eberlein","year":"2008","journal-title":"Am J Med Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.ccm.2016.04.003","article-title":"Plastic bronchitis.","volume":"37","author":"Rubin","year":"2016","journal-title":"Clin Chest Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1164\/rccm.202307-1246IM","article-title":"Plastic bronchitis related to idiopathic lymphatic regurgitation.","volume":"210","author":"He","year":"2024","journal-title":"Am J Respir Crit Care Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"6020","DOI":"10.12998\/wjcc.v12.i27.6020","article-title":"Clinical approach for pulmonary lymphatic disorders.","volume":"12","author":"Thamkittikun","year":"2024","journal-title":"World J Clin Cases."},{"key":"B32","doi-asserted-by":"publisher","first-page":"103283","DOI":"10.1016\/j.jaccas.2025.103283","article-title":"Lymphatic abnormalities in fontan: case report of plastic bronchitis.","volume":"30","author":"Torres-G\u00f3mez","year":"2025","journal-title":"JACC Case Rep."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e590","DOI":"10.1542\/peds.2013-3723","article-title":"Successful treatment of plastic bronchitis by selective lymphatic embolization in a Fontan patient.","volume":"134","author":"Dori","year":"2014","journal-title":"Pediatrics."},{"key":"B34","doi-asserted-by":"publisher","first-page":"101174","DOI":"10.1016\/j.jscai.2023.101174","article-title":"Lymphatic imaging and intervention in congenital heart disease.","volume":"3","author":"Bauer","year":"2024","journal-title":"J Soc Cardiovas Angiography Intervent."},{"key":"B35","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1164\/rccm.201503-0631im","article-title":"Plastic bronchitis related to idiopathic thoracic lymphangiectasia. noncontrast magnetic resonance lymphography.","volume":"192","author":"El Mouhadi","year":"2015","journal-title":"Am J Respir Crit Care Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/(sici)1099-0496(199911)28:53.0.co;2-k","article-title":"Bronchial casts in children with cardiopathies: the role of pulmonary lymphatic abnormalities.","volume":"28","author":"Languepin","year":"1999","journal-title":"Pediatric Pulmonol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"113","DOI":"10.7861\/futurehosp.6-1-s113","article-title":"Cognitive bias in the clinical decision making of doctors.","volume":"6","author":"O\u2019Hagan","year":"2019","journal-title":"Future Healthcare J."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1825038\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:33:13Z","timestamp":1777527193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1825038\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":37,"alternative-id":["10.3389\/fmed.2026.1825038"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1825038","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"article-number":"1825038"}}