Pneumoradiography

Pneumoroentgenography is a method of X-ray examination of internal organs using gas (air, oxygen, carbon dioxide, nitrous oxide) as a radiopaque substance. The name of this diagnostic method comes from the Greek word “pneumo”, which means “air”. Gas as a contrast is used to contrast those structures that are normally filled with liquid or are hollow.

Gases are X-ray negative substances, that is, they freely pass X-ray rays, so the structure filled with a gaseous substance in the picture looks like a dark spot. Thanks to this, it is possible to assess the state of the inner shell of the organ under study.

Indications and contraindications

Pneumoroentgenography has long been an indispensable diagnostic method in neurosurgery, oncology, urology, gynecology, therapy, and gastroenterology. Depending on the organ into which gas contrast is injected, pneumoroentgenography of the ventricles and cisterns of the brain, subarachnoid space, stomach and large intestine, soft tissues of the extremities, uterus and bladder are distinguished.

Pneumoencephalography is indicated for hydrocephalus, adhesions in the subarachnoid space, congenital malformations of the structures of the liquor system of the brain, suspected tumors inside the cerebral ventricles.

X-ray examination with gas is indicated for gastric ulcer, tumors of the stomach wall (pneumogastrography), Crohn’s disease, ulcerative colitis, neoplasms, fistulas in the intestines, abnormal development of the intestines (pneumoirrigography).

Pneumohysterography is an informative study of the uterine cavity, which is prescribed for infertility, anomalies in the development of the female reproductive system, and suspicion of vesicouterine fistula.

If a diverticulum or bladder tumor is suspected, bladder stones are prescribed pneumocystography. Air as a contrast is also used to determine the size and depth of lesions of soft tissue tumors of the extremities.

Contraindications for this diagnostic method include pregnancy, bleeding of unknown origin, pathology of the blood coagulation system, inflammatory processes in the examined organ.

Given that pneumoroentgenography is performed using ionizing radiation, it cannot be performed for those patients who have repeatedly undergone X-ray examination over the past year.

Some methods of X-ray examination using gas contrast have already lost their relevance. For example, pneumoperitoneum, when less traumatic and highly informative other diagnostic studies are used – magnetic resonance and computed tomography.

Preparation and procedure

It is necessary to properly prepare for the pneumoroentgenographic procedure. The training program depends on the body that is planned to be examined. So, before irrigography, it is imperative to clean the intestines well (a couple of days of fasting and a cleansing enema on the evening before the study). Enema is also indicated before any pneumocontrast procedure, regardless of the location of the organ under study. The procedure is carried out on an empty stomach.

The stages of the pneumoroentgenography procedure differ depending on the organ(s) that are to be examined.

Pneumoencelography is performed in a hospital and combined with lumbar puncture. Immediately before the procedure, a puncture is made between the third and fourth lumbar vertebrae, the pressure of the cerebrospinal fluid is measured, 2-3 ml of cerebrospinal fluid is taken, and then gas (oxygen or air) is slowly injected. At the same time, the position of the patient’s head is regularly changed in order to evenly fill all the ventricles and subarachnoid space with gas. During the introduction of gaseous contrast, it is necessary to constantly monitor intracranial pressure.

The ingress of air or other gas into the cerebrospinal fluid is accompanied by vegetative disorders (blanching of the skin, drop in blood pressure, dizziness, headache, sweating), excitation of the patient.

Air irritation of the arachnoid membrane is accompanied by a pronounced pain effect, so the pneumoencephalography procedure is performed under anesthesia.

Pneumogastrography is performed 2-3 days after the contrast study of the stomach with barium sulfate: this way the greater curvature of the stomach is better contrasted. No special preparation before the examination after a contrast barium X-ray examination is required. Only in case of constipation after the previous examination should the patient be given a cleansing enema in the evening. Before pneumogastrography, an excited patient may be given sedatives or antispasmodics.

Air is introduced into the stomach for pneumogastrography using a special nasal probe made of elastic plastic. The use of this probe does not injure the mucous membrane of the nasal passages and esophagus, as it has a diameter of up to 0,3 cm. During the study, you can easily control the localization of the probe in the stomach (it has a metal tip). With it, you can inflate the stomach even if the probe is brought to the lower third of the esophagus.

At the beginning of pneumogastrography, an overview image of the abdominal organs is taken in a horizontal position, while examining the cardial part of the stomach – in a vertical position. Then they begin to fill the organ with air, while as it is filled with gas, several consecutive shots are taken in different projections. The filling of the stomach with gas should be maximum so that all its folds are straightened.

Pneumohysterography is performed on an outpatient basis. With increased sensitivity of the cervix, the patient is given local anesthesia. The main indication for gas contrasting of the uterus is to establish the degree of obstruction of the fallopian tubes.

During the study, the uterus is periodically filled with gaseous contrast, since gas can exit through the fallopian tubes into the abdominal cavity. By making a series of contrast images, it is possible to confirm or exclude such a cause of infertility as obstruction of the fallopian tubes.

Today, pneumoroentgenography is losing its relevance. There are new, more informative and at the same time painless diagnostic methods that allow to identify pathological changes in organs at different stages of the disease.

Pneumoroentgenography in today’s diagnostics remains relevant only in gastroenterology (examination of the stomach and intestines), neurology (examination of the ventricles, cisterns of the brain and subarachnoid space) and gynecology (determination of the cause of infertility).

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