Easy removal of a large mucus plug with a flexible paediatric bronchoscope after administration of rhDNase (Pulmozyme)

Abstract

Mucoid impaction and plastic bronchitis are relatively rare disorders affecting patients of any age. Here we report the case of mucoid impaction developing in a four-year-old child as a complication of pneumonic infection treated four weeks prior. p.a. chest X-ray and fiberoptic bronchoscopy showed atelectasis and the location of a mucus cast in the left upper lobe. After extraction of the cast via the suction channel of the bronchoscope had failed, we administered 2.5 mg of undiluted recombinant human deoxyribonuclease (rhDNase) instilled directly over the affected area of occlusion for 15 minutes. This mucolytic agent mobilized the cast by reducing viscoelasticity and adherence of mucus. Subsequent extraction of the mucus cast was easy, resulting in immediate reduction of atelectasis and discharge of the child the following day. Treatment of severe mucus plugging by direct instillation of rhDNase has been a safe and efficacious procedure for mobilising adherent mucus plugs and for facilitating bronchoscopic extraction.