Drugs used:
Contrasting the bronchi allows you to obtain comprehensive data on the state of the lumen bronchial tree, as well as about cavity formations communicating with the bronchi. Indications and contraindications for bronchography, methods of pain relief, positive and negative properties of various contrast agents, methods of their administration are described in detail in a number of monographs.
However, bronchography can be effective only if the bronchial tree is prepared for examination. In this case, the amount of sputum produced per day should not exceed 50 ml. Otherwise, the contrast agent will not be able to evenly fill the bronchial tree, which leads to incorrect interpretation of the existing changes. For a patient with significant sputum production, bronchography is performed before bronchography, which includes diagnostic bronchoscopy and a series of conventional tracheobronchial sanitation under local anesthesia. At the same time, the patient becomes familiar with endobronchial manipulations and corresponding sensations, which psychologically prepares him for bronchography.
In most cases, it is advisable to perform bronchography under local anesthesia (Hirsch's mixture, novocaine, etc.), the thoroughness of which determines the quality of the study.
They usually use a 2.4% solution of trimecaine, which has no side effects with a large therapeutic latitude. 7-10 ml are consumed per study permissible quantity for an adult 15-20 ml of solution.
To administer a contrast agent, double-lumen controlled Rosenstrauch-Smulevich catheters are used, which are especially convenient for performing directional bronchography. In the absence of the specified special catheter, a regular catheter can be used urethral catheter with a cut end.
As a contrast agent, most researchers use sulfoidol in a ratio of 10-13 gsulfodimezine per 20 ml of iodolipol (depending on the viscosity of the incoming batch of iodolipol). Since the Research Institute of Pulmonology performs up to 10 bronchographies during the working day, the entire amount of iodolipol and sulfodimezine required for this is mixed automatically in a mixer, heated to body temperature and stored in a thermostat. A warm contrast agent is easier to squeeze out of the syringe, has a less irritating effect on the bronchial mucosa and penetrates more easily into the small bronchi.
Under the control of an X-ray screen or television installation, the bronchial tree is filled; the optimal degree of filling and optimal projection are selected. Before taking pictures, the catheter is removed from the bronchial tree. Pictures are taken in standard lateral and anterior projections, then in one of the oblique projections. In addition, if necessary, photographs are taken at different phases of breathing. According to indications, tomobronchography and cine-bronchography are performed.
Patients with chronic inflammatory lung diseases usually4 require bilateral examination. In this regard, we perform sequential bilateral contrasting of the bronchial tree with an interval of 4-5 days. If there is any localized lesion, it is advisable to start the study with directional (selective) bronchography. With a certain skill, a controlled catheter can be inserted into any segmental bronchus. After contrasting the bronchus of the affected section, the study ends with filling the remaining bronchi of the lung under study.
In some cases, it is necessary to perform bronchography under anesthesia. Bronchography in conditions is advisable when studying children, with possible development bronchospasm, with pulmonary hemorrhage, if necessary, in combination with bronchoscopy.
The pain relief technique is similar to that performed for, and it is described in detail in the above manuals. It is most convenient to use a double-lumen Carlens tube for intubation, which provides ventilation of the opposite lung at the time of filling of the bronchial tree. Sulfoiodol or water-soluble substances (propyliodone, jeliodon, jeliopaque, etc.) are used as a contrast agent. Pictures are taken in a state of apnea in three projections - lateral, posterior, oblique.
The main disadvantage of bronchography performed under anesthesia is the distortion of the picture of the bronchial tree due to hypoventilation of the examined lung. The bronchi in this case appear tortuous and deformed. To avoid this undesirable phenomenon, the examined lung is hyperventilated before the administration of the contrast agent. After administration of a contrast agent, if there is insufficient uniform distribution it, an additional volume of air is introduced (Friedel maneuver). After bronchography, the contrast agent is aspirated as much as possible.
Each of the described methods of bronchography has its own positive and negative sides. Bronchography under anesthesia provides conditions for performing a comprehensive bronchological examination, including in children (bronchoscopy, bronchography, bronchial catheterization, biopsy, puncture lymph nodes), but requires sophisticated equipment and a well-trained team of doctors of various specialties (radiologist, anesthesiologist, bronchologoscopist). Bronchography under local anesthesia is technically simpler and at the same time allows you to study the function of the bronchial tree, take pictures in various projections, film or record on a video recorder. Depending on the objectives and existing conditions, one or another method of anesthesia is selected to contrast the bronchial tree.
Morphological changes in the bronchi detected on bronchograms may depend on reversible disorders, for example, on swelling of the bronchial mucosa and hypersecretion (breaks in the filling, fragmented filling of the bronchus, uneven contours due to local accumulations of mucus, a decrease in the number of branches), or on irreversible changes characterizing picture of deforming, bronchostenosis, etc. The nature of changes in the bronchial tree cannot always be clarified with a single study, and for final decision it is necessary to repeat bronchography after a course of sanitation.
Along with morphological changes Bronchography can reveal some signs characterizing functional abnormalities. Thus, with a well-developed technique, in a number of cases uneven ventilation of the bronchi is detected, especially when bronchial asthma(according to our data, in 25% of patients in the interictal period).
A significant role in studying the function of the bronchi during bronchography is played by taking pictures in different phases of breathing (functional bronchography according to S. A. Oganesyan). Normally, when you inhale, the lumen of the bronchus becomes wider, the bronchus lengthens somewhat, and when you exhale, the bronchus shortens and its lumen becomes narrower. At pathological conditions Rigidity of the walls may be observed, as a result of which the width of the bronchial lumen practically does not change during breathing. In other cases, hypotension develops, and the bronchial lumen during exhalation sharply decreases until it completely disappears (expiratory). Both conditions sharply disrupt the drainage function of the bronchi. Functional changes accompany and often precede the development of morphological manifestations of the pathological process.
To detail some changes, a combination of bronchography and tomography is used. This modification is especially effective when studying local changes in the bronchial wall, as it reduces the projection overlap of other elements. In order to reduce radiation exposure, it is necessary to use a simultaneous cassette.
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Exploration of the lower respiratory tract, which allows you to obtain an x-ray image of the trachea and bronchi after introducing a contrast agent into them.
The main indication for bronchography is to confirm or exclude bronchiectasis. Bronchography is also used in cases of suspected congenital anomaly of the respiratory system, chronic suppurative lung diseases, tracheal and bronchial stenosis, bronchopleural and bronchoesophageal fistulas, inflammatory diseases lungs, “simulating” a peripheral neoplasm.
Bronchography, as a rule, is preceded by bronchoscopy, which identifies pathology of the trachea and bronchi down to the subsegmental branches and allows one to determine the patient’s readiness for bronchographic examination. If there is a large amount of secretion in the lumens of the bronchi, before bronchography, sanitation of the bronchial tree is carried out, aimed at restoring the drainage function and improving bronchial patency, facilitating the obtaining of bronchograms more High Quality. The bronchography technique differs significantly depending on whether the study is performed under general anesthesia or local anesthesia. The most common type of pain relief is local anesthesia. General anesthesia is used in children under 8 years of age, with intolerance to local anesthetics, and with bronchospastic reactions to endobronchial administration of a catheter and contrast agent under local anesthesia. For any type of anesthesia, premedication is prescribed: 0.1% atropine sulfate - 1.0; 1% diphenhydramine - 2.0 or 2% promedol - 1.0. Local anesthesia is produced by irrigating the nasal passages of the oropharynx and vocal folds with one of the anesthetics: 2.4% trimecaine, 2-4% lidocaine (total dose no more than 500 mg), 1% dicaine or cocaine (total dose no more than 40 mg). For endobronchial administration of a contrast agent, special rubber catheters are used, in particular those controlled using a polyamide thread, as well as other types of catheters, for example, those made from a duodenal tube, ureteral, etc. Under local anesthesia, the catheter is passed through the lower nasal passage into the oropharynx, and then on inspiration, it moves through the glottis into the trachea, after stretching the tongue and tilting the head back. Local anesthesia of the respiratory tract is completed by installing an anesthetic through a catheter, which is then installed in the intermediate bronchus under x-ray control. right lung or at the mouth of the lower lobe bronchus of the left lung. In this position, the bronchial branches of one lung are filled with a contrast agent through a catheter. Then radiographs are taken in frontal and lateral projections.
Bronchography under anesthesia can be performed through a bronchoscope tube or through an endotracheal tube. The second method is more preferable. A rubber or polyethylene catheter for bronchography is inserted into the endotracheal tube through a special adapter-tee, which allows the installation of a contrast agent against the background of ongoing artificial ventilation lungs. After bronchography is performed, the contrast agent is aspirated from the bronchial tree.
For bronchography, various X-ray contrast agents are used - iodine-oil (iodolipol), viscous aqueous suspensions of iodine preparations (dionosil, bromdiagnostin), water-soluble iodine compounds with colloidal solution cellulose (propyliodone), powdered preparations (tantalum). Iodolipol has almost no irritating effect on the bronchial mucosa, but has low viscosity and easily penetrates into the alveoli, where it can linger long time. An increase in the viscosity of iodolipol is achieved by adding sulfadimezine powder at the rate of 5-8 g per 10 ml. Bronchography using sprayed tantalum powder is used mainly for diagnosing pathology of the trachea and large bronchi.
Bronchography– X-ray examination of the bronchial tree, which is carried out after the introduction of an iodine-based radiopaque substance into the bronchi. After the contrast envelops the walls of the bronchi from the inside, they become clearly visible on x-rays.
Purpose of the study: assess the condition of the lumen of the bronchial tree, as well as cavity formations communicating with the bronchi.
Indications for bronchography:
Developmental defects of the tracheobronchial tree,
Inflammatory processes bronchi,
Bronchial tumors,
Bronchiectasis.
Contraindications to bronchography:
Acute infectious diseases,
Severe violations respiratory functions, of cardio-vascular system, liver or kidneys,
Patient intolerance to radiocontrast agents.
Preparing the patient for the study:
1. Explain to the patient the essence of the study and the rules for preparing for it.
2. Obtain the patient's consent for the upcoming study.
3. Inform the patient about the exact time and place of the study.
4. It is necessary for the patient to undergo a number of studies before bronchography:
- radiography chest in two projections: direct and lateral;
- electrocardiography to clarify the state of the cardiovascular system;
- spirography– a study that allows you to evaluate functional state respiratory system;
- general tests blood and urine;
- determination of blood group and Rh factor– since, in essence, bronchography is equivalent to surgical intervention.
5. Ask the patient to repeat the preparation for the study, especially in an outpatient setting.
6. Find out allergy history, since the study is carried out with a contrast agent.
Carrying out bronchography. Bronchography is performed by a doctor. Bronchography is carried out on a dental chair or on an operating table, which can be given a suitable configuration.
Mandatory room equipment for bronchography:
· X-ray machine;
· catheter or bronchoscope to introduce contrast into the lungs;
X-ray contrast agent;
· resuscitation kit.
Progress of the study:
· The patient is placed on the dental chair or operating table. He should take the most comfortable and relaxed position - this will facilitate the examination.
· If bronchography is performed under general anesthesia. The anesthesiologist gives the patient mask anesthesia. After this, the mask is removed from the face and the trachea is intubated.
· If bronchography is performed under local anesthesia. Anesthesia is administered using a spray oral cavity. Then a bronchoscope is inserted, through which an anesthetic is administered, and then a radiocontrast agent.
· Before injecting contrast into the bronchi, the doctor can perform a bronchoscopy - examine the mucous membrane using a bronchoscope.
· The contrast should evenly fill the bronchi and be distributed along their walls. For this, the patient is turned over several times, giving him different positions.
· Then perform a series x-rays. After this, the study is completed.
Conducting research: The examination is carried out by a doctor. The patient's position during the procedure is lying down.
Conclusion: The doctor gives the conclusion in writing.
The lungs are the organ that carries out important function breathing. Therefore, lung tissue is sensitive to the influence of an unfavorable environmental situation, viral diseases and tobacco smoke.
According to the latest statistics, 37% of the country's population smokes. So early diagnosis diseases of the bronchopulmonary system using highly informative methods, which include bronchography, becomes a priority task for both doctors and patients.
What is the research?
Bronchography - x-ray method studies of the tracheobronchial tree using an iodine-containing contrast agent injected into the bronchi.
To carry out the manipulation you must have:
- Fiberoptic bronchoscope (a fiber-optic device in the form of a thin flexible tube, at the end of which there is a camera and a light source, for performing bronchoscopy).
- A device for taking x-rays.
Contrast is administered using a catheter or bronchoscope. To relieve discomfort and painful sensations The procedure is performed under general anesthesia or local anesthesia.
Types of bronchography
Bronchography, depending on complexity diagnostic task and existing data about the disease, it happens:
- Panoramic (non-directional, total) - the entire tracheobronchial tree is contrasted. Most often, this option is used in the initial stages, when there is no accurate information about the localization of the pathological process.
- Directed (selective, selective) - using a fiberoptic bronchoscope, contrast is introduced into the segmental bronchus and then spreads through the bronchi of a smaller diameter. The method is indicated to clarify the diagnosis, as it allows you to see changes at levels inaccessible to plain bronchography.
In addition, there is bronchokymography - a method that allows you to study the functional state of the respiratory system. If the bronchi are filled with contrast, an x-ray is taken - photographs of several respiratory acts. The motor function of the bronchial tree is assessed during coughing and at the height of inhalation (exhalation).
Indications for the study
Due to the possibility of assessing the condition of small caliber bronchi, before the advent of computer and magnetic resonance imaging methods, bronchography was the only method for diagnosing pathological processes located there.
The study is carried out in the following cases:
- Bronchiectasis.
- Stenosis (narrowing of the lumen) of bronchi of all calibers.
- Oncological diseases of the lungs.
- Chronical bronchitis.
- Pulmonary tuberculosis.
- Congenital anomalies bronchopulmonary system (hypoplasia - underdevelopment of lung tissue).
- The presence of bronchopleural fistulas (pathological “tunnels” between the bronchus and the chest cavity).
- Assessment of the condition of the bronchial stump after resection (removal).
The conditions listed above are not full list diagnostic capabilities. Bronfography is also used for dynamic monitoring of the patient in order to monitor the effectiveness of treatment.
Contraindications for bronchography
As for any other medical manipulation, for bronchography there are a number of conditions in which the study is prohibited or undesirable.
Absolute contraindications:
- Pulmonary hemorrhage.
- Decompensated pathologies of the cardiovascular system (myocardial infarction suffered less than 6 months ago, cardiomyopathy, etc.).
- Allergic reaction to the substances used.
- Kidney or liver failure.
- Mental illnesses.
Relative contraindications:
- Acute pneumonia or bronchitis.
- Thyrotoxicosis grade 3-4 (consultation with an endocrinologist is required).
- Aneurysms (pathological expansion of the lumen with thinning of the wall) of large vessels of the chest cavity.
- Temperature above 38° C.
- Pregnancy and lactation.
- Children under 3 years old.
The research is always planned and therefore all risks and difficulties are taken into account. In the presence of relative contraindications, it is possible if the diagnostic value of the method exceeds the likelihood of adverse reactions.
How to prepare for research
Patient preparation depends on the existing pathology. In the presence of purulent-inflammatory diseases, sanitation (cleaning) of the tracheobronchial tree through a nasal catheter is carried out 2-3 days before the study. Preliminary rinsing increases bronchial patency and reduces the manifestations of the inflammatory process.
1-2 days before, the patient undergoes an allergy test with the contrast agent that will be used.
In addition, you must first undergo the following studies:
- General blood and urine analysis.
- Blood type and Rh factor.
- Blood test for coagulogram (clotting indicators).
- ECG (electrocardiography).
- X-ray of the lungs in two projections.
How is the bronchography procedure performed?
The patient is in a reclining position on the operating table or chair. To more completely fill the bronchus on one side, the patient may be asked to turn onto the corresponding side.
After anesthesia (using a spray or pipette, 5.0 ml is injected into the nose local anesthetic or intravenous anesthesia), a catheter or bronchoscope is inserted through one of the nostrils.
Important! Bronchography is prohibited for children under local anesthesia.
After the onset of anesthesia, the bronchi are filled with iodine-containing contrast through the outer part of the probe using a syringe. The amount of solution required is 15-20 ml per lung. Then pictures are taken in two projections (frontal and lateral).
For bronchophonography, only local anesthesia is used and, after contrast is administered, the patient is asked to breathe deeply and cough several times. A digital x-ray of 6-10 images is taken.
Removal of the contrast agent is possible using suction through a catheter. However, given the small amount of fluid administered, the patient himself coughs up most of it 20-30 minutes after the examination. After 24 hours, the drug is not detected in the bronchi.
To overcome discomfort and a sore throat for several hours after the procedure, it is recommended to use lozenges or lozenges with anesthetics (Strepsils).
Advantages of this method
Bronchography is an informative, fast and technically uncomplicated method. However, due to the availability of modern diagnostic studies, it is worth comparing its advantages and disadvantages.
Given the relative ease of execution and the indisputability of the results obtained, bronchography remains the method of choice for diagnosing diseases such as bronchiectasis. However, this procedure is equivalent to a surgical intervention, so its prescription is carried out exclusively by a doctor strictly according to indications.
Possible complications after bronchography
The use of anesthesia for research, the introduction of a foreign contrast agent into the lumen of the bronchus against the background of already existing disease may lead to the development undesirable consequences. Most often they arise due to:
- Toxic effects medicines. The most common manifestations: dizziness, weakness, chills, excessive sweating.
- Allergic reaction in contrast, manifested in the form anaphylactic shock(a serious condition caused by poor circulation and accompanied by bronchospasm, falling blood pressure, loss of consciousness).
- Trauma to the mucous membrane of the respiratory tract with a bronchoscope: nose bleed, hemoptysis. It is also possible inflammatory reactions from the pharynx and larynx (pharyngitis, laryngitis).
In addition, bronchography can lead to exacerbation of the underlying disease. The risk of complications is higher in patients for whom the study was carried out in the presence of relative contraindications.
How to decipher the results of bronchography
The examination results are assessed jointly by the radiologist and the attending physician. The table below shows the pathologies respiratory organs and corresponding changes on the bronchogram.
|
Disease |
Bronchographic picture |
|
Central lung cancer (neoplastic tumor located in the main or lobar bronchi) |
|
|
Peripheral lung cancer (neoplasm in subsegmental and smaller diameter bronchi) |
|
|
Bronchiectasis |
|
|
Chronical bronchitis |
|
Doctor's advice! If you suspect oncological pathology lungs, the bronchoscopy method is more informative. Bronchography complements endoscopic examination
Conducted in accordance with strict indications and with the availability of modern equipment, bronchography is a highly informative method for diagnosing bronchopulmonary diseases. Comprehensive examination the patient, taking into account the results of laboratory and radiological studies, is often decisive in making a diagnosis and choosing tactics for further action.
Bronchography is a radiographic method for studying the bronchial tree using a contrast agent and taking pictures.
The radiologically determined pulmonary pattern is due mainly blood vessels and connective tissue stroma of the lungs. The branches of the bronchial tree are almost invisible on x-ray.
The image of large bronchi (main and sometimes lobar) can be obtained on overexposed photographs taken at the height of inspiration, while smaller bronchi are not visible on them either. The possibilities of layer-by-layer research are also limited - usually the trachea, main and lobar bronchi are determined.
A complete picture of the condition of the bronchial tree can only be obtained with the help of a contrast X-ray examination - bronchography.
The bronchography method has been put into practical use since 1923, when Sicard and Forestier proposed filling the bronchial tree with lipiodol - organic compound yoda with vegetable oil. In our country, the Soviet drug iodolipol is currently used for bronchography. The latter is a transparent oily liquid of a brownish-yellowish color, containing 30% iodine, packaged in ampoules. Iodolipol provides a clear contrast image of the bronchi and is well tolerated by patients.
Bronchography technique
An hour before bronchography, the patient receives 0.1 g of diazepam orally, which, like other barbiturates, reduces the toxic effect of lidocaine used for anesthesia of the respiratory tract, suppresses the cough reflex and causes more shallow breathing, which contributes to the effectiveness of the study.
The study is carried out in the morning, preferably on an empty stomach.
Of the numerous methods of anesthetizing the respiratory tract and introducing a contrast agent into them, the most widely used is the so-called transnasal catheterization method.
Anesthesia of the respiratory tract is best done with Hirsch's mixture. For this, the patient is seated with his head thrown back. Using a pipette, 1-1.5 ml of Hirsch's mixture is injected dropwise into the nasal passages over 5 minutes at intervals of 1-2 minutes. The patient deeply inhales the injected solution.
Anesthesia of the upper respiratory tract can also be performed using a special atomizer. The same amount of anesthetic mixture is sprayed into the area of the root of the tongue, pharynx and larynx.
After anesthetizing the upper respiratory tract, the patient is asked to stick out his tongue and hold it with a gauze pad, and the person standing in front of him inserts a rubber catheter through his nose into the trachea. After this, the patient lies on a table installed behind the translucent screen. The screen checks whether the catheter is in the trachea and at what level (it should be brought to the bifurcation). Then an additional 1-1.5 ml of Hirsch’s mixture is injected into the lumen of the catheter to anesthetize the area of the bifurcation of the trachea and large bronchi.
2-3 minutes after the anesthesia is completed, the patient is placed in a lateral position according to the lung being examined and a contrast agent, iodolipol, is poured into the bronchial tree through a catheter.
A known disadvantage of iodolipol, like every other oily contrast agent (lipiodol, iodipine), is that, having penetrated the alveoli, it lingers there for many days, and sometimes weeks and months. The alveoli, as is known, are freed from iodolipol not by coughing, but as a result of the breakdown and absorption of the lipoid substance by the lung tissue.
Therefore, viscose materials that are quickly released from the body were proposed for contrast studies of the bronchial tree. aqueous solutions iodine preparations uroselectan and perabrodil. However, this solution has a number of disadvantages: they strongly irritate the bronchial mucosa, causing prolonged cough and sometimes asthmatic attacks; the contrast of the image of the bronchial tree is less than with oily substances.
In order to prevent iodolipol from entering the alveoli, it is recommended to increase its viscosity by mixing it with highly dispersed powders, in particular with sulfonamides. Most often, iodolipol is thoroughly mixed with norsulfazole in the following proportion: 3 g of norsulfazole for every 10 ml of iodolipol. When using this suspension, no contrast agent is detected in the lungs in the next few days after bronchography.
For a survey of one lung, in most cases it is enough to administer 20 ml of iodolipol, and only in case of multiple large bronchiectasias or cavities in the lung, the amount of iodolipol is increased to 30 ml.
The filling of the bronchial tree with a contrast agent can be seen on the screen. Usually you have to raise the top or bottom part torso or tilt the patient forward or backward so that the contrast agent is evenly distributed throughout the bronchial tree of the lung being examined.
After using the screen to obtain an idea of the state of the bronchial tree or of the cavities in the lung filled with a contrast agent, two survey bronchograms are made with the horizontal direction of the X-rays: one with the patient in the lateral position (in the so-called lateroposition) and the other with the patient in the back. It must be borne in mind that as soon as the patient takes vertical position, iodolipol quickly leaves the upper bronchial branches and accumulates in the lower branches.
After producing bronchograms with the patient positioned on his side and on his back, fluoroscopy is continued (and, if necessary, additional images are taken), first with the patient in a supine position, and then in an upright position.
Sometimes, for example, when diagnosing bronchial cancer or focal forms of pneumosclerosis, there is a need for a targeted bronchographic study with dosed administration of a contrast agent. In these cases, a catheter under the control of a screen is inserted into the corresponding lobar bronchus and the bronchial branches of the ventilated lobe are filled with a small amount (3-5 ml) of iodolipol. The latter, spreading in a thin layer over the inner surface of the bronchial wall, allows you to study its condition in detail on a translucent screen and on targeted photographs.
If bronchography of the second lung is necessary, it should be performed several days after the contrast study of the first lung.
Complications of bronchography
In the early years of bronchography use, anesthetic poisoning was quite common. Nowadays, due to changes in anesthesia techniques, only mild cases of poisoning sometimes occur.
Poisoning manifests itself as the following symptoms: euphoria, motor agitation, difficulty swallowing, dizziness, severe pallor of the skin, cold sweat, dilated pupils, rapid and small pulse.
The phenomena of poisoning are stopped by inhaling amyl nitrite, ingesting a solution (1: 1000) of nitroglycerin (0.5 ml up to one time), subcutaneous injection camphor and caffeine. It turns out to be especially effective in these cases, according to the observations of a number of authors, intravenous infusion 5-10 ml of 15% calcium chloride or 2 ml of 10% hexenal, or 10-15 ml of 2% pentothal.
Another complication of bronchographic examination is the phenomenon of iodism. It is usually observed among individuals who did not undergo an iodine sensitivity test before the study.
Some patients after bronchography experience an increase in temperature in the next 2 days after the examination, but most patients tolerate bronchography well, and many note a decrease in sputum production after the examination and the disappearance of its foul odor.
Indications for bronchography
The use of bronchography is indicated primarily for patients with chronic purulent diseases lungs.
Signs of bronchiectasis determined by conventional, non-contrast studies are very unreliable. In the vast majority of cases, only a contrast study can reliably establish or exclude the presence of bronchial dilatations.
No less great is the importance of bronchographic examination in recognizing chronic abscesses. With a conventional X-ray examination, it is very difficult to detect an abscess cavity, since it is often not differentiated among the darkening caused by massive infiltrative-indurative changes in the lung tissue and pleural layers. With bronchography of this type, abscesses are easily filled with a contrast agent and become clearly visible.
Contrast research in suppurative processes of the lungs makes it possible to obtain an accurate idea of the anatomical localization of the process according to the segmental structure of the lungs, which greatly contributes to resolving the issue of indications and scope of surgical intervention.
When diagnosing bronchogenic cancer, bronchography is especially valuable when the bronchi are affected, which are inaccessible to examination with a bronchoscope. However, bronchography is not mandatory method research in lung cancer. In the vast majority of cases, conventional X-ray examination, supplemented by tomography, provides convincing evidence of the presence cancerous tumor, its topography and prevalence, which in such cases makes the use of contract research unnecessary. Bronchography should be used only for diagnostic purposes. difficult cases. The presence of a bronchial cast pattern on the bronchogram, which is a pathognomonic sign lung cancer, allows you to reliably establish the correct diagnosis.
IN last years Bronchography has also been used in patients with tuberculosis with fibrotic forms in order to diagnose bronchiectasis developing in them. Some authors recommend using contrast X-ray examination to diagnose cavities and determine the nature of pleural adhesions in ineffective pneumothorax (to decide whether the adhesion contains lung tissue or not).
Contraindications to bronchography
Bronchography should not be performed in severely weakened, exhausted patients, as well as in those with high fevers (with a body temperature above 38°).
Bronchography is contraindicated for kidney disease, decompensated heart disease, active forms of pulmonary tuberculosis and Graves' disease.
The article was prepared and edited by: surgeon
