On the Nature of Peculiar Expectorated Bronchial Casts: Can Infrared Spectroscopy Enlighten Us?

Background: Bronchial casts can be defined as gelatinous structures originating from the airways. While several cases of bronchial cast formation have been reported in literature, unravelling its nature is often a difficult task.

Methods: In this case report, we applied infrared (IR) spectroscopy on a bronchial cast fragment originating from a patient who suffered from a 2-y history of frequent coughing accompanied by the occasional expectoration of viscous and thick white-yellow bronchial-like structures.

Results: Based on a markedly high lipid to protein ratio and presence of long-chain fatty acids, the resulting IR spectrum appeared to be very suggestive for chyloptysis.

Conclusion: Taking into account the patient's prior history of radiation therapy for a lymphoma complicated by congestive heart failure, we hypothesized that an impairment of adequate lymphatic flow into the venous system due to a combination of lymphatic obstruction and high venous pressures is the most plausible culprit.