Bronchography by Atomization

Abstract

Atomization of the opaque medium for bronchography can be accomplished by placing the tip of the atomizer at the larynx behind the epiglottis, in the trachea below the vocal cords, or at the main bronchus. Technic: We anesthetize the base of the tongue, pharynx, larynx, and trachea by a 1 per cent solution of pantocaine, vaporized, with the patient in the sitting position on the x-ray table. We have tried different opaque media but at present we use 20 per cent lipiodol; usually from 10 to 15 c.c. is necessary. The atomization lasts about two minutes. It is very important to use a good and well timed radiographic technic since all our efforts would be lost if we did not obtain good roentgenograms at the right moment and in the best position. For supratracheal atomization we place the tip of the atomizer in the larynx behind the epiglottis. During the atomization the patient remains in the sitting position inclined to the side to be explored and leaning forward or backward according to the location of the pulmonary segment to be examined. Immediately after the atomization, he is placed in the horizontal position and, according to the side and pulmonary segments to be explored, the necessary roentgenograms are obtained. For the upper lobes the Trendelenburg position is used. For atomization at the larynx, a DeVilbiss No. 152 atomizer can be used, but we find a longer one more useful. The atomizer is connected by a rubber tube to an air compressor, such as is employed by the laryngologists, and from 6 to 8 pounds of pressure are used. For intratracheal atomization we have constructed a long atomizer which permits a very fine atomization, the tip of which can be easily placed below the vocal cords with the help of a laryngeal mirror. The atomization is done following anesthesia, with the patient sitting on the x-ray table. Immediately after the atomization he is placed in various positions according to the different pulmonary segments to be explored. The technic is the same as for supratracheal atomization. It is very important to keep the patient from coughing. For intrabronchial atomization we use a No. 16 rubber catheter, through which we pass a No.8 urethral catheter. The first carries the air and the second the lipiodol. Both are connected to a small atomizing chamber that we can regulate in order to produce a very fine spray. After anesthetizing the nasal fossa and the larynx, pharynx, and trachea with a pantocaine spray, we pass the catheter through the nose into the trachea. The patient is then taken to the fluoroscopic table and the atomizing chamber is placed in the main bronchus of the side to be examined. We then vaporize the opaque medium in different positions for the different pulmonary segments, and roentgenograms are taken. Very fine details of the bronchial mucosa may be observed. All the bronchial tree of one side can be examined, films being taken in the different positions for each pulmonary segment. If necessary, the bronchial tree of the other side may be examined after two or three days. There is no considerable accumulation of lipiodol, since the amount used is small and the atomized medium is rapidly eliminated.