Plastic bronchitis is a rare but serious clinical disorder characterized by the formation of widespread casts in the bronchial airways. This is primarily encountered in the pediatric population following a cardiac surgery (particularly post-Fontan procedure). Various treatment and management strategies have been used with differing success for cast removal and symptomatic relief. We describe one such case, wherein all the traditionally described medical therapies did not provide sustained amelioration of symptoms and required transfer for thoracic duct ligation. The patient’s clinical and radiographic features, management strategies, and clinical course are reviewed, alongside a brief review of the currently available management strategies for the clinical practitioner in dealing with plastic bronchitis.