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Ectopic right bronchus: indication for bronchography.

Ectopic right-sided bronchus is a rare anomaly. In this retrospective study, eight patients are described. All were from a population that clinically was suspected of suffering from chronic bronchitis. In one patient, the ectopic bronchus was missed on bronchoscopy but not on bronchography; in the other seven patients bronchoscopy and bronchography both revealed the ectopic bronchus. The first patient had a persistent inhomogeneous consolidation only in the ectopic area with extensive bronchiectasis; one patient had slight bronchiectasis; the other six patients had none of these pathologic alterations. Only in the first patient did the anomaly have therapeutic consequences, as there was an extensive bronchiectasis. In patients with a persistent inhomogeneous consolidation, only on the site of the apical segment of the right upper lobe may an ectopic bronchus with extensive bronchiectasis be suspected. In such patients, a bronchographic examination is indicated.

Adult↗

[Indications and limitations of bronchography in surgery of carcinoma of the lung].

Starting from a consecutive series of 53 bronchographies performed under local anesthesia, in subjects with carcinoma of the lung ascertained by operation, the Authors analyse both the bronchographical aspects which most frequently come under the surgeon's observation, and the usefulness of this investigation in formulating the operating plan. As regards carcinomas of the large and medium bronchi, the bronchographic aspects they found most frequently are occlusion (82%) both in the form of sudden arrest and in the form of a cone image and stenosis (18%). In peripheral carcinomas, on the other hand, most characteristic bronchographic signs are identified as occlusion (58%) (amputation and stenosis) and dislocation (38%) with rigidity of one or more small calibre bronchi (rigid impairment). On the basis of their experience the Authors conclude that bronchography constitutes an almost indispensable examination for diagnostic purposes in malignant neoplasias, especially in the initial stage, when located outside the field of action of bronchoscopy, and can supply elements indispensable in the preoperative operatability judgement. In fact it not only gives very reliable information on the anatomical situation of the bronchus, as well as on the site and presumed starting-point of the neoplasia, but also supplies more approximate elements with regard to the extent of the neoplasia and any presence of lymphoglandular metastases.

Bronchial Neoplasms↗

[A comparative study of HRCT and digital subtraction bronchography of bronchiectasis].

OBJECTIVE: To assess the value of HRCT in the diagnosis of bronchiectasis at segmental level. METHODS: 29 cases (522 segments) with bronchiectasis doubted by clinical evaluation were selected and HRCT scan and digital subtraction bronchography (DSB) were performed. RESULTS: HRCT and DSB showed a good identity in the diagnosis of bronchiectasis. Of 92 segments diagnosed as bronchiectasis in HRCT, 84 were agreed with DSB; Of 430 segments diagnosed as no bronchiectasis by HRCT, 425 were agreed with DSB. Sensitivity of HRCT is 94%, specificity is 98%. The main HRCT findings were cylindric and cystic bronchiectasis. CONCLUSIONS: HRCT is superior to bronchography for bronchiectasis. It is the first choice of the image diagnostic modalities for the patients in whom bronchiectasis is suspected.

Adolescent↗

Oxygen saturation after bronchography under general anaesthesia.

Thirty-six patients undergoing bronchography or bronchoscopy under general anaesthesia were continuously monitored by pulse oximetry for 5 hours after these procedures. Significant falls in oxygen saturation were observed in the first hour and were of most clinical relevance in patients with preexisting pulmonary dysfunction who underwent bronchography. These results support the recommendation that supplementary oxygen should be provided for all patients undergoing this investigation.

Adult↗

Bronchography in patients with suspected lung malignancy.

Bronchography and flexible fiberoptic bronchoscopy (FFB) were performed on 95 patients with suspected lung malignancy. Finally, 66 of 95 lesions turned out to be malignant and 29 benign. Bronchographic diagnosis was correct in 46 of 66 cases of cancer (70%) but gave a false negative result in 20 malignant lesions and a false positive result in four benign lesions of which three had pulmonary tuberculosis and one hamartoma of the lung. It is concluded that bronchography is rarely indicated in central malignant lesions. In peripheral lesions bronchographic findings for malignancy are unreliable or negative.

Adult↗

Comparison between pulmonary emphysema and chronic bronchitis: an assessment by selective alveolo-bronchography.

In order to elucidate the interrelationship between pulmonary emphysema and chronic bronchitis, 23 adult patients with chronic obstructive pulmonary disease were examined during life by selective alveolo-bronchography. They were classified according to radiologic criteria as centrilobular or panlobular emphysema or chronic bronchitis and according to clinical criteria as A, B or X types. A and B clinical types proposed by Burrows and Fletcher were almost in agreement respectively with emphysema and chronic bronchitis based on x-ray criteria. However, no correlation between A-type and panlobular emphysema or between B-type and centrilobular emphysema were observed. Centrilobular emphysema was diagnosed in 4 patients who had no history of findings of bronchitis. This suggests that inflammation of airways is not necessarily a cause of centrilobular emphysema. As a result, selective alveolo-bronchography was thought to be useful method to diagnose the type and severity of emphysema.

Aged↗

[Unilateral bronchography at a young age and ventilatory function].

In 21 males, aged about 20, 18 out of them with chronic bronchopulmonary diseases (bronchiectases, focal fibrosis, deforming bronchitis) and three healthy--VC, FEFR1, FVC, MMV50, MEFR200-1200, MAEFR, MAEFR25-75 and MEFR50 and MEFR90 were spirographically investigated prior to, two hours afert and 24 hours after unilateral bronchography; the three of the investigations were combined with a subsequent inhalation bronchodilatation test with orziprenalin--aersol (alupent). A mixed (restrictive-obstructive) ventilation syndrome with bronchospasm was established to develop after the bronchography. The restrictive syndrome is prevailing and that is conditioned by the absence of a definite manifestation of the obstruction at the level of the flow rates with small pulmonary volmes. The restrictive syndrome is admitted to be conditioned by "fear of coughing and the obstructuve-by the opaque medium and bronchospasm after the injection of the opaque substance.

Adult↗

HYTRAST: A NEW CONTRAST MEDIUM FOR BRONCHOGRAPHY.

In 1962 Hytrast, an aqueous suspension containing 50% w/v of combined iodine as a mixture of N-(2,3-dihydroxypropyl)-3,5-diiodopyridone-4 and 3,5-diiodopyridone-4, was introduced as a contrast medium for bronchography. Extensive clinical trials had suggested that this agent was superior to products usually employed for this purpose. At the Nova Scotia Sanatorium, Hytrast was used as a bronchographic contrast medium in 31 consecutive cases. For comparison purposes, the records of the first 50 patients in whom another contrast medium, Dionosil Oily, was used were reviewed. In all cases the contrast medium was introduced through a catheter passed into the bronchus with the aid of a laryngeal mirror, after local anesthesia was induced by pontocaine 2%. Experience in this limited number of cases was at variance with most published results. Hytrast was more irritating than Dionosil Oily, had a greater tendency to produce alveolarization, caused more frequent undesirable sequelae, and was retained in the lung for prolonged periods.

Adolescent↗

Changes in regional and overall lung function after bronchography.

This investigation compares the effects of unilateral bronchography on classical pulmonary function parameters (spirometry, CO transfer, flow-volume curve, and arterial blood gases) and radioisotopic measurements by means of 99mTc-labeled microspheres and 81mKr. The regional changes of ventilation and perfusion were quantified by a radioisotopic index, which was established for each zone of interest: explored lung and unexplored lung. The quantitative study of regional perfusion and ventilation reveals significant reduction of ventilation for lung bases, but not for lung apices. The radioisotopic measurements show a reduction of perfusion parallel to the reduction of ventilation. There is no significant correlation between traditional pulmonary function parameters and isotopic indices. Radioisotopy proved a sensitive tool for investigation of unilateral alterations.

Adult↗

Bronchiectasis in childhood. Comparison of chest roentgenograms, bronchography and lung scintigraphy.

In 76 children, 102 unilateral bronchograms were compared with the results of chest radiography and Tc-99m perfusion scintigraphy to assess the presence of bronchiectasis. Additional Kr-81m ventilation lung scintigraphy was obtained in 16 patients. For the chest radiograph the sensitivity was 73% and the specificity was 76%. For lung scintigraphy the sensitivity was 92% and the specificity 60%. When both chest radiography and lung scintigraphy were considered, sensitivity reached 96% and specificity fell to 53%. Forty per cent of the bronchrograms which were performed might have been avoided on the basis of the normal chest radiograph and lung scintigraphy. The combination of lung scintigraphy and chest radiography is an excellent screening method when a decision on the advisability of bronchography is being taken in children.

Adolescent↗

Death associated with bronchography. Question role of heating the contrast agent.

A young woman died following bronchography. The bilateral bronchogram done under general anesthesia without fluoroscopic control was associated with extensive small airway filling or "alveolarization" of the contrast medium. The oily Dionosil used had been heated in an autoclave. Experiments showed that the viscosity of oily Dionosil decreases with heating. The lowered viscosity could have contributed to the increased "alveolarization" of the contrast agent and death of the patient.

Adult↗

Accessory cardiac bronchus and tracheal bronchus anomalies: CT-bronchoscopy and CT-bronchography findings.

Most common developmental anomalies of bronchial tree include accessory cardiac bronchus (ACB) and tracheal bronchus (TB). Minor bronchial anomalies include variants of TB, displaced segmental bronchi, and bronchial agenesis. We present CT-bronchoscopy and CT-bronchography findings of three cases with either ACB or TB. Recognition of these anomalies is important, as associated clinical complications, including recurrent episodes of infection, hemoptysis, and perhaps malignancies may be anticipated in a small percentage of patients.

Adult↗

Value of virtual tracheobronchoscopy and bronchography from 16-slice multidetector-row spiral computed tomography for assessment of suspected tracheobronchial stenosis in children.

PURPOSE: To evaluate the value of dose-reduced 16-slice multidetector-row spiral computed tomography (16-MDCT) using virtual tracheobronchoscopy (VTB) and virtual bronchography (VBG) in children with suspected tracheobronchial stenosis. MATERIALS AND METHODS: 12 children (4 d to 3 years, body weight 1.2 kg to 13.5 kg) with stridor and suspected tracheobronchial stenosis were examined by contrast-enhanced low-dose 16-MDCT. Conventional axial slices, MPRs, VTB, and VBG were calculated. Image findings were correlated with the results of fiberoptic bronchoscopy (12 out of 12) as a gold standard and subsequent surgery (8 out of 12). RESULTS: VTB and VBG demonstrated the fiberoptic bronchoscopically suspected tracheal stenosis in 11 of 12 children due to vascular compression because of the brachiocephalic trunk (6), a double aortic arch (2), a vascular compression of the left main bronchus (2), and a right aberrant subclavian artery (1). Eleven out of 12 stenoses were correctly depicted by conventional axial slices, MPRs, VTB, and VBG. Dose reduction was 79 to 85.8% compared to a standard adult chest CT. CONCLUSION: Dose-reduced 16-MDCT with the use of VTB and VBG is effective for the evaluation of tracheobronchial stenosis in children and correlates well with fiberoptic bronchoscopy.

Airway Obstruction↗

Pleuroma--a cancer-mimicking atelectatic pseudotumor of the lung. 55 consecutive cases studied by high KV radiography, bronchography, selective pulmonary angiography and needle biopsy.

A form of cancer--mimicking atelectatic pseudotumor of the lung called "pleuroma" is described. Since 1961 55 cases were studied by needle aspiration biopsy. Due to the usual "negative" results ("no cancer cells") of the needle biopsy, a radiographic pattern was recognized, of the basis of which the benignity of the lesion was correctly diagnosed in most cases. The radiographic appearance of these lesions was not only established with PA, lateral and oblique high KV radiographs, fluoroscopy with overpenetrated spot films, but also by bronchography, and selective pulmonary angiography. Needle biopsy was helpful in conforming a diagnosis in typical cases. However it was of paramount importance in atypical cases to recognize the lesion.

Adult↗

Biological disposition of perfluoroctylbromide: tracheal administration in alveolography and bronchography.

Perfluoroctylbromide, given tracheally either as neat liquid in alveolography or as 10:1 emulsion in bronchography, was cleared roentgenologically from the lungs within 24 hours. Quantitative analysis was performed on a gas chromatograph. The rats were given either 2 ml/kg of neat liquid or 0.4 ml/kg emulsion. One per cent of the neat liquid and 8% of the emulsion were recovered from the tissues respectively 24 hours later. The lungs had the largest amount followed by the intestine, adipose tissue and lymph nodes. Dogs were sacrificed at various intervals following 4 ml/kg of neat liquid or 2 ml/kg of emulsion. Less than 1% of the dose was found in the tissues at 24 hours. A similar pattern of perfluoroctylbromide distribution was observed as in the rats. The tissue contents of perfluoroctylbromide at three months were below the limit of detection. The perfluoroctylbromide levels in the blood and urine of dogs and human volunteers were either non-detectable or barely detectable over a 48-hour period.

Animals↗

Bronchial web diagnosed by bronchography.

Bronchial webs are rare lesions which often go unrecognized. The authors describe a patient who presented with right-lower-lobe bronchiectasis and at-electasis secondary to a web in the right-lower-lobe bronchus. This is the first known instance where such a lesion has been demonstrated by bronchography. The etiology of this and similar lesions reported in the literature remains obscure.

Bronchi↗

Bronchofiberscopy with curette biopsy and bronchography in the evaluation of peripheral lung lesions.

Flexible bronchofiberscopy using a double-hinged curette biopsy and under fluoroscopic guidance was performed on 46 patients with peripheral lung carcinomas smaller than 2 cm. Prior mapping of the location of the lung lesion was achieved with selective peripheral bronchography. With these diagnostic tools, a positive cytologic diagnosis for lung carcinomas was made in 45 of 46 patients, a yield of 97.8 percent. Complications associated with the curette biopsy included minor bleeding in three cases and pneumothorax requiring a chest tube in one case.

Adult↗

Barium sulfate bronchography. Report of a complication.

Alveolarization of the barium sulfate and subsequent retention of barium sulfate for years was demonstrated in three patients in whom dilute suspension of barium sulfate in water was used for bronchography. Pathologic examination in one patient showed barium sulfate within macrophages in the alveolar spaces and walls and in the perivascular and peribronchial interstitium. Since the residual barium sulfate interferes with imaging procedures of the lungs, it represents an unwanted event in patients with pulmonary disease. High-resolution computed tomography is the preferred method of evaluating for bronchiectasis. If bronchogram is performed, it should be performed after bronchoscopy using oily propyliodone (Dionosil).

Adult↗