Beschreibung
Since the respiratory airways branch to all parts of the lungs and ready access is provided through the nose or mouth, exploration of these passages for direct visualization or tissue sampling has long been a clinical challenge. This would be particularly helpful in diagnosing those pulmonary diseases that involve the bronchial tree or affect the surrounding lung parenchyma which prove difficult to diagnose or define by indirect methods. The pioneering efforts of Chevalier Jackson in 1918, using bismuth insufflation for radiologic visualization of the bronchial tree, and of Sicard and Forestier, who introduced poppy seed oil (lipiodol) in 1922, rapidly established bronchography as a practical radiologic diagnostic procedure. The initial enthusiasm was soon tempered by recognition of practical problems, and over the years the popularity of bronchography has waxed and waned as techniques were refined and new equipment, instrumentation and contrast agents evaluated. At the same time, alternative methods of diagnosis were being developed, notably sputum cytology, percutaneous needle aspira tion and biopsy, and bronchial brushing. In recent years, a number of medical and technologic developments have revived interest in transbronchial techniques and have made such a diagnostic approach more attractive. Improvements in topical airway anesthesia effectiveness have simplified passage of a variety of catheters, brushes, biopsy devices, fiberoptic or other bronchoscopic instruments along the bronchial passageways. Methods of guiding the catheter or other trans bronchial instrument toward the target site in the lung have also been refined.
Autorenporträt
InhaltsangabeI. Expansion of Bronchography into Bronchial Catheterization.- II. The Role of Bronchial Catheterization.- A. Indications.- B. Relationship to Other Techniques.- C. Contraindications.- III. Bronchial Catheterization Technique.- A. General Requirements for Performing Bronchial Catheterization.- 1. X-Ray Equipment.- 2. Patient Preparation and Anesthesia.- a) Patient Preparation.- b) Local Anesthesia.- c) General Anesthesia.- d) Respective Positions of Local and General Anesthesia.- B. Bronchography.- 1. Contrast Medium.- 2. Catheters.- 3. Opacification.- 4. Pitfalls and Complications.- C. Bronchial Brushing.- 1. Material 48.- 2. Procedure 51.- 3. Pitfalls, Complications, and Drawbacks 51.- 4. Brushing and Bronchography 51.- D. Bronchial Dynamics (Cineradiography).- 1. Dynamic Recording.- 2. Recording of Intraesophageal Pressure.- 3. Measurement of Endobronchial Pressure.- 4. Correlations Between Cineradiography and Pressure Curves.- 5. Errors with and Inadequacies of the Method 56.- IV. The Normal Bronchogram.- A. Procedures and Standards of Bronchial Filling Using Televised Fluoroscopy.- B. Static Images.- 1. Normal Tracheobronchial Division and Its Variants.- 2. The Peripheral Sector.- C. Normal Bronchial Dynamics.- V. The Pathologic Bronchogram.- A. Bronchial Filling Anomalies.- B. Position and Orientation Anomalies of the Bronchial Tree.- C. Variations in Bronchial Caliber.- 1. Reductions in Caliber of the Bronchial Lumen.- 2. Increases in Bronchial Caliber.- D. Bronchial Contour Abnormalities.- E. Anomalies of the Bronchioloalveolar Segment.- VI. Contributions of Bronchography and Bronchial Brushing to the Diagnosis of Opacities and Pulmonary Ring Shadows.- A. Diagnosis of Pulmonary Opacities.- B. Diagnosis of Pulmonary Ring Shadows (in the Adult).- VII. Contributions and Value of Bronchography and Bronchial Brushing in Pulmonary Pathology.- A. Bronchiectasis.- 1. Objectives of Bronchography.- 2. Analysis of the Bronchogram.- 3. Evolution of Bronchiectasis.- 4. Etiology of Bronchiectasis.- B. Chronic Bronchitis.- 1. Objectives of the Examination.- 2. Analysis of the Bronchogram.- 3. Bronchographic Forms.- 4. Evolution of the Lesions.- 5. Correlations.- 6. Borderlines Between Chronic Bronchitis and Bronchiectasis.- C. Tumors of the Lung.- 1. Malignant Tumors.- a) Bronchial Carcinoma.- b) Bronchoalveolar Carcinoma.- c) Bronchopulmonary Sarcoma.- d) Pulmonary Metastases.- e) Lymphangitic Spread.- 2. Benign or Slowly Evolving Tumors, Hydatid Cysts.- a) Benign or Slowly Evolving Tumors.- b) Hydatid Cysts.- D. Delayed-Resolution Pneumopathies and Chronic Pneumonia.- 1. Position of Bronchography and Brushing.- 2. Bronchographic Signs.- 3. Diagnosis Based on Roentgenographic Manifestations.- E. Cavitied Pulmonary Suppurations.- 1. Bronchographic Manifestations.- 2. Contribution of Bronchography to the Diagnosis of Pulmonary Suppurations.- F. Tuberculosis.- 1. Objectives of Bronchography.- 2. Bronchographic Manifestations.- 3. Diagnostic Problems.- G. Bronchopulmonary Malformations.- 1. Anomalies of the Trachea.- 2. Bronchial and Pulmonary Anomalies.- H. Bronchography and Pleural Pathology.- 1. Bronchographic Signs in Pleural Pathology.- 2. Contribution of Bronchography to Pleural Pathology.
