Bronchography is a method of special radiopaque examination, which allows to obtain a distinct shadow image of the macrostructure of the tracheobronchial tree. It allows to diagnose bronchiectasis, intraluminal tumors, stenosis, obstruction of the bronchus by a foreign body, to determine the level of localization of the lesion for subsequent resection. It is performed by introducing a radiopaque substance into the lumen of the altered bronchi through a nasal catheter or a fibrooptic bronchoscope followed by a series of targeted radiographs.
The need for bronchography is determined individually after other types of examination – radiography, bronchoscopy, etc. The procedure is prescribed if the information obtained during other procedures does not allow to verify the diagnosis. The main complaints of patients are severe shortness of breath (at rest or with little physical exertion), the discharge of a large amount of sputum, the presence of blood or other pathological impurities in it.
Among the diseases that bronchography reveals, the first place is occupied by bronchiectatic disease. Bronchiectasis is the expansion of the bronchial lumen, which is most often a complication of chronic respiratory diseases (tuberculosis, pneumonia, etc.). Bronchography is used to determine the location and size of bronchiectasis, based on the study data, a decision is made on conservative therapy or the need for surgery, an operation plan is drawn up taking into account the localization of bronchiectasis. The procedure is quite informative in the diagnosis of congenital or acquired anomalies of the development of the bronchial tree, malignant and benign neoplasms, the consequences of injuries.
There are a number of diseases in which bronchography is categorically contraindicated. These include myocardial infarction less than 6 months old, acute cerebrovascular accident (stroke), epilepsy, traumatic brain injury in the acute period, liver and kidney dysfunction. Severe pathology of the respiratory system (pronounced stenosis of the upper respiratory tract, etc.) is also an absolute contraindication to the appointment of the study. Bronchographic examination is not performed in patients with allergic reactions to substances that are part of the contrast.
Relative contraindications include
- exacerbation of chronic diseases of the bronchopulmonary system (bronchial asthma, chronic obstructive bronchitis, bronchiectatic disease)
- acute inflammatory processes in the upper respiratory tract (tracheitis, laryngitis, pharyngitis), pulmonary bleeding
Bronchography is cautiously prescribed to patients
- with decompensated diabetes mellitus
- with thyroid pathology.
During pregnancy, diagnosis is allowed only if there are emergency indications and not earlier than 20 weeks.
Bronchography does not require special preparation. In the presence of purulent sputum, drainage is carried out using the appropriate position in bed, the appointment of expectorants and bronchodilators. The patient should refuse to eat 8 hours before the study. Immediately before the procedure, you need to empty the bladder and remove the dentures.
Methodology of conducting
Bronchography is performed in a specially equipped room. A bronchoscope and an X-ray machine are used for examination. Bronchography is performed under local or general anesthesia. In the first case, an endoscope is inserted through the oral or nasal cavity into the respiratory tract, with the help of which an anesthetic is first supplied, and then a coloring substance (an iodine-containing drug or a barium suspension). At the same time, the patient needs to change the position of the body for an even distribution of contrast. The final stage is the execution of a series of images in various projections. At this point, the bronchography is considered completed. The patient can take the conclusion and the developed X-ray film a few hours after the end of the procedure.
Bronchography is necessary to determine the condition of all structures of the bronchial tree. Normally, the main bronchi will be clearly visualized on the X-ray. The right one, unlike the left one, is shorter and wider, has a more vertical arrangement. The lumen of the bronchi gradually narrows as it divides into branches of a lower order. Shadows or cavities filled with contrast should not be detected along the course of the bronchi. When a pathological focus is detected, the radiologist determines its shape, uniformity, size, shadow intensity, and contour clarity. Based on the conclusion of the radiologist, the clinical picture and data from other diagnostic methods, the attending physician can make a final diagnosis and begin treatment of pathology.