Bronchography

Bronchography refers to X-ray methods for examining the condition of the lungs with the use of contrast agents. Unlike a conventional X-ray procedure, in this case, the patient is first injected with a special contrast agent into the organs under study. Due to the contrast that envelops the walls of the bronchi, they can be seen in great detail in the pictures, and the bronchial structure can be carefully examined. For this reason, the results of bronchography are considered more accurate and valuable compared to the data of an endoscopic procedure – bronchoscopy. However, for example, when choosing between the appointment of computed tomography and bronchography, doctors most often tend to prescribe the first examination option, as more easily tolerated by patients.

The structure of the bronchi and bronchial tree, the basis for diagnosis

The bronchi are a segment of the lower respiratory tract and provide air transfer directly to the alveoli of the lungs.

The bronchial system is represented by many hollow tubules, which branch out and gradually narrow towards the periphery. The smaller the diameter of the tube, the thinner its wall. The terminal branches of the bronchi are called bronchioles, they end the bronchial tree. The main function of the bronchial tree is the ventilation function, that is, the conduction of air and the continuation of the processing of air entering the lungs.

Visually, the entire bronchial system really resembles a tree with branches. Its basis (“trunk”) is the trachea, from the continuation of which the two main largest pulmonary bronchi depart. At the same time, the left bronchus is a longer tube, has a more horizontal position, and a smaller diameter of the lumen. The right bronchus is located vertically, it is shorter and wider. From these main bronchi, the lobar bronchi depart, which are divided into segmental, and segmental further into subsegmental. The smallest and thinnest bronchi are lobular and bronchioles. There are muscle fibers in the bronchial walls – their number is inversely proportional to the diameter of the bronchus. These fibers are able to regulate the size of the lumen, thus controlling the flow of air to the lung tissue. The lung parenchyma is formed by the alveolar tree. Each terminal bronchiole is dichotomously divided into respiratory or respiratory bronchioles, in the walls of which individual alveoli are already defined. From each respiratory bronchiole, alveolar passages depart, ending in alveolar sacs, which are formed by alveoli. The structural and functional unit of the lung parenchyma, at the level of which gas exchange occurs, is the acinus. An acinus is a branching of a single respiratory bronchiole that is surrounded by blood capillaries.

A detailed study and study of the bronchial tree, including with the help of bronchography, makes it possible to identify the causes of certain disorders in the functioning of the lungs, determine the functional pathologies of development and the nature of inflammatory or tumor processes at the bronchial level, and also identify cavity formations communicating with the bronchi.

Indications and contraindications for carrying out, disadvantages of the technique

In cases where the patient complains of the appearance of atypical symptoms, sensations in the airways, the separation of atypical contents when coughing, the doctor may prescribe bronchography as a detection method:

• bronchiectasis – extensions of the segmental bronchi, which manifest as bronchiectasis in a chronic form. In areas of expansion, bronchial fluid accumulates and pathogenic bacteria begin to multiply intensively;
• indications for surgical intervention – for example, for the pathology presented above, when drug treatment does not work;
• causes of hemoptysis, increased sputum volume, dyspnea, other symptoms of lung damage;
• additional data on the condition of the bronchi, for example, in combination with bronchoscopy;
• congenital malformations and pathologies;
• causes of chronic inflammatory processes in the lungs;
• the reasons for the reduction in the size of the lung or pathological processes identified on conventional x-rays;
• a cavity in the lung that changes in size over time.

The procedure is recommended for patients before surgery on the lungs, as well as after them, to control the effectiveness of surgery.

There are conditions and objective factors in which the appointment of bronchography for a particular patient is impossible. Among the absolute contraindications:

• the presence of an allergy to iodine and contrast agents;
• intolerance to anesthetics used during the operation;
• a period of 6 months after myocardial infarction;
• acute period of cerebral stroke;
• significant cardiac arrhythmias;
• hypertension in cases where the lower blood pressure is above 100 mm Hg. Art.;
• severe narrowing of the trachea and larynx;
• a three-week period after an exacerbation of bronchial asthma;
• skull trauma in the acute period, epileptic seizures and other neurological disorders;
• pain in the abdomen, as well as the general serious condition of the patient.

In the presence of relative contraindications, the question of the possibility of conducting bronchography is decided by the doctor, taking into account all the features of the patient’s condition. These contraindications are:

• SARS or flu;
• angina pectoris;
• severe diabetes mellitus;
• second half of pregnancy;
• alcoholism;
• menstruation in women;
• progressive pulmonary tuberculosis;
• pneumonia;
• pulmonary bleeding of any etiology;
• enlargement of the thyroid gland of the third degree (you must first visit an endocrinologist).

To date, computed tomography is considered a more harmless and accurate method for diagnosing the condition of the bronchi. Compared with it, the bronchographic method has known disadvantages:

• the need for anesthesia;
• the likelihood of an allergy to iodine and iodine-containing drugs;
• radiation exposure factor on the body: some patients are generally contraindicated to get under x-ray exposure, but for those for whom there are no such restrictions, it is not recommended to do x-rays in any form more than once every six months.

Indications for the procedure in patients with tuberculosis

Tuberculosis is one of the most common infectious diseases in the world that affects the lungs. He has a fairly high mortality rate, but timely detection, as well as adequately selected therapy, give a high chance of recovery.

When affected by this disease, some disorders and features of the functioning of organs may develop, which the attending physician monitors, including using the results of bronchography.

The procedure is given:

• if you suspect the presence of bronchiectasis;
• with suspicion of bronchial stenosis;
• to detect a cavity (a void formed as a result of tissue death), if it could not be identified by other means;
• with suspicion of perforation of a caseous lymph node into the lumen of the adjacent bronchus;
• to study the bronchus stump after lung resection;
• to identify or clarify the presence of a bronchial fistula opening into the pleural or extrapleural cavity;
• for differential diagnosis, when it is necessary to distinguish tuberculosis from other diseases.

Usually the procedure is carried out in parallel with the complex of anti-tuberculosis treatment.

Features of preparation for the procedure

The doctor who ordered the examination advises the patient on all requirements, explains to him how to prepare for anesthesia. If the operation is planned under local anesthesia, the patient is forbidden to eat 2 hours before. If general anesthesia is used, this time is increased. The doctor should find out the presence or absence of intolerance to any substances, allergies to iodine.

In advance, you need to carry out thorough hygiene measures to cleanse the oral cavity. If the patient uses dentures, they must be removed before starting the procedure.

The doctor also pre-directs the patient to such examinations:

• X-ray of the chest in two projections;
• electrocardiography;
• spirography;
• coagulogram;
• general analysis of urine and blood.

If the patient complains of a severe cough with copious sputum, 3 days before the bronchography, he is prescribed strong expectorants, or a postural drainage procedure is performed.

How is a bronchography performed?

In some cases, the operation in adults takes place without anesthesia at all, but the patient feels severe discomfort. Most often, local anesthesia is used for adults. Half an hour before the start of the procedure, he is given special drugs that suppress coughing and expand the lumen of the bronchi. Immediately before the start of the manipulation, local anesthesia is performed using a spray. For young children, the use of general anesthesia is mandatory.

Before starting the process, the patient is placed on the operating table, while he should take the most relaxed and comfortable position. If the operation is performed under general anesthesia, a mask is applied to the face of the patient to administer the anesthetic. After the patient enters the drug sleep state, the mask is removed and tracheal intubation is performed. With local anesthesia, after treatment of the oral cavity, the patient is introduced a bronchoscope through which an anesthetic is supplied, followed by a contrast agent. Before their introduction, the doctor may, if necessary, conduct a bronchoscopy. As a contrast agent, most often, sulfiodol with sulfadimezin is used.

In order for the contrast to be evenly distributed over the lungs, the subject is turned over several times, changing his position. After that, X-ray imaging is carried out in frontal, lateral and other projections. This method of carrying out the procedure is called positional.

Directed bronchography is used to study the lower lobe bronchus and the system of segments of the lower lobe of the lungs, as well as the middle lobe of organs. The patient with the introduction of a contrast agent is in the “standing” position.

Possible complications during and after the procedure

Bronchography, although performed by competent professionals and with careful preparation, is not a completely safe diagnostic method. During bronchography, the patient may develop an acute allergic reaction to an iodine-containing drug or anesthesia. Perhaps the development of anaphylactic shock, dizziness, vomiting and nausea, increased heart rate, drop in blood pressure, loss of consciousness. Physicians should be prepared for the possibility of developing nosebleeds due to trauma to the mucous membrane during the insertion of a bronchoscope. If the researcher has a sharp spasm of the bronchi, he feels a lack of air, suffocation and shortness of breath, and he also has blue skin. In any of the cases described, it is necessary to stop the procedure and provide the patient with the necessary medical care.

For the first time after the examination, the patient will feel pain symptoms and a sore throat. To get rid of discomfort, it is enough to rinse the mouth and throat with special solutions, for example, a decoction of oak bark, or dissolve lozenges for sore throats.

As a result of the use of anesthesia, the swallowing reflex may be temporarily impaired, since the anesthetic inhibits the work of nerve endings on the pharyngeal mucosa. Usually this symptom disappears within 2 hours after the end of the procedure, and the patient is forbidden to drink and eat until the complete restoration of swallowing.

To speed up the process of removing the contrast agent from the bronchi, it is recommended to perform breathing exercises, in some cases – postural drainage.

Bronchography is usually carried out in a hospital, but in cases where the procedure is carried out in a clinic, after it, a sick leave is opened for the patient for a day.

Interpretation of survey results

The normal condition of the bronchi means that the bronchial tree retains the correct shape and texture on the bronchography image, the main bronchi have their usual shape, thickness and position, as the branching decreases, the thickness of all bronchi gradually decreases, there are no shadows or cavities filled with contrast or atypical bronchial constriction.

If pathological formations are found in the picture, the doctor evaluates their shape, number, location, size, contours, displacement and boundaries, after which he decides whether to conduct further examinations or prescribe treatment.

Bronchography is considered a fairly reliable and accurate method for studying lung pathologies, but it is not completely safe. In some cases, computed tomography is recommended instead of a bronchography procedure.

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