Bronchography

Description:

Contrasting of bronchial tubes allows to obtain exhaustive data on a condition of a gleam of a bronchial tree, and also on the band educations which are reported with bronchial tubes. Indications and contraindications to a bronchography, ways of anesthesia, positive and negative properties of various contrast agents, ways of their introduction are in detail described in a number of monographs.

However the bronchography can be effective only on condition of preparation of a bronchial tree for a research. At the same time the quantity of the phlegm allocated in days should not exceed 50 ml. Otherwise a contrast agent will not be able evenly to fill a bronchial tree that leads to the wrong interpretation of the available changes. To the patient with considerable department of a phlegm before a bronchography sanitation of a bronchial tree which includes a diagnostic bronkhoskopiya and a series of usual tracheobronchial sanitation under local anesthesia is made. At the same time the patient gets acquainted with endobronchial manipulations and the corresponding feelings that psychologically prepares him for a bronchography.

It is in most cases reasonable to carry out a bronchography under local anesthesia (Girsh's mix, novocaine, etc.) on which care quality of a research depends.

2,4% use usually solution of Trimecainum which has no side effects at big therapeutic width. 7 — 10 ml at admissible quantity for adult 15 — 20 ml of solution are spent for one research.

For administration of contrast medium the dvukhprosvetny managed Rozenshtraukh's catheters — Smulevich, especially convenient for performance of the directed bronchography are used. In the absence of the specified special catheter the usual urethral catheter with the cut-off end can be used.

As a contrast agent most of researchers uses сульфойодол in the ratio 10 — 13 gsulfodimezin on 20 ml of Iodolipolum (depending on viscosity of the arrived party of Iodolipolum). As in scientific research institute of pulmonology during the working day about 10 bronchographies are carried out, all the quantity of Iodolipolum necessary for this purpose and Sulfodemezinum mixes up automatically in the mixer, is warmed up to body temperature and kept in the thermostat. A warm contrast agent is easier squeezed out from the syringe, possesses smaller irritant action on mucous a bronchial tube gets into small bronchial tubes easier.

Under control of the x-ray screen or television installation filling of a bronchial tree is made; optimum extent of filling, an optimum projection is chosen. Before production of pictures the catheter from a bronchial tree is removed. Pictures are carried out in standard side and front projections, then in one of slanting projections. Besides, if necessary pictures in various phases of breath become. According to indications the tomobronkhografiya, a film bronchography is carried out.

Patients with chronic inflammatory diseases of lungs, as pravilo4 need a bilateral research. In this regard we carry out bilateral contrasting of a bronchial tree, consecutive at an interval of 4 — 5 days. In the presence of any localized defeat it is reasonable to Begin a research with the directed (selective) bronchography. The managed catheter at a certain skill can be entered into any segmental bronchus. After contrasting of a bronchial tube of the struck department the research comes to an end with filling of other bronchial tubes of the studied lung.

In some cases it is necessary to carry out a bronchography under anesthetic. The bronchography in the conditions of an anesthesia is reasonable at a research of children, at possible development of a bronchospasm, at pulmonary bleeding, in need of its combination to a bronkhoskopiya.

The technique of anesthesia is similar to that which is carried out at a bronkhoskopiya, and it is in detail described in the managements stated above. Use is the most convenient for an intubation of the dvukhprosvetny tube of Karlens providing ventilation of an opposite lung at the time of filling of a bronchial tree. As a contrast agent it is applied сульфойодол or water-soluble substances (пропилйодон, желйодон, желиопак, etc.). Pictures are made in a condition of an apnoea in three projections — side, back, slanting.

The main lack of the bronchography which is carried out under anesthetic is distortion of a picture of a bronchial tree owing to hypoventilation of the studied lung. Bronchial tubes in this case are represented gyrose, deformed. In order to avoid this undesirable phenomenon the studied lung before administration of contrast medium giperventilirutsya. After administration of contrast medium, at insufficiently its hypodispersion, the additional volume of air (Friedel's reception) is entered. After a bronchography a contrast agent is as far as possible aspirated.

Each of the described ways of a bronchography has the positive and negative sides. The bronchography under anesthetic provides conditions for performance of a complex bronkhologichesky research, including at children (a bronkhoskopiya, a bronchography, catheterization of bronchial tubes, a biopsy, a puncture of lymph nodes), but demands the difficult equipment and well trained team of doctors of various specialties (the radiologist, the anesthesiologist, a bronkhologoskopist). The bronchography under local anesthesia is technically simpler and at the same time allows to study function of a bronchial tree, to carry out pictures in various projections, to make filming or record on the videorecorder. Depending on objectives and the available conditions this or that way of anesthesia for contrasting of a bronchial tree is chosen.

The morphological changes in bronchial tubes revealed on bronkhogramma can depend on reversible disturbances, for example on hypostasis mucous a bronchial tube and hypersecretion (filling breaks, the fragmented filling of a bronchial tube, roughness of contours because of local accumulations of slime, reduction of number of branches), or on the irreversible changes characterizing a picture of the deforming bronchitis, bronchiectasias, bronchostenoses etc. The nature of changes of a bronchial tree can not always be found out at a single research, and for the final decision it is necessary to repeat a bronchography after a course of sanitation.

Along with morphological changes the bronchography can reveal some signs characterizing functional deviations. So, at well fulfilled technique in some cases uneven ventilation of bronchial tubes is found, in particular at bronchial asthma (according to our data, in 25% of patients in the mezhpristupny period).

An essential role in studying of function of bronchial tubes at a bronchography is played by performance of pictures in various phases of breath (a functional bronchography according to S. A. Oganesyan). Normal at a breath the gleam of a bronchial tube becomes wider, the bronchial tube is a little extended, at an exhalation the bronchial tube is shortened and its gleam becomes already. At morbid conditions rigidity of walls as a result of which bronchial tube gleam width at breath practically does not change can be observed. In other cases hypotonia develops, and the bronchial tube gleam on an exhalation is sharply fallen down up to total disappearance (an expiratory collapse). Both the state sharply breaks drainage function of bronchial tubes. Functional changes accompany and quite often precede development of morphological manifestations of pathological process.

For detailing of some changes the bronchography combination to a tomography is used. This modification is especially effective when studying local changes in a bronchial tube wall as it reduces projective imposing of other elements. For the purpose of reduction of beam loading it is necessary to use the simultaneous cartridge.