Increasing scope of bronchography with dionosil.

Abstract

Prior to 1955, Iodochlorol was used routinely in the radiography of the bron-chial tree at the John Sealy Hospital, University of Texas, Medical Branch, in Galveston. With few exceptions, bronchography was considered to be indicated only for confirmation of the diagnosis of suspected bronchiectasis and for the subsequent preoperative mapping of all the lobes. Alveolar retention for many months tended to mask future lung infiltrations, prevented early re-examination, and even resulted in delay in performing surgical procedures. With a rapidly absorbable medium, these objections are overcome. We chose to use Dionosil, which is completely absorbed in the average patient in one to four days. With the adoption of this opaque medium, we began to apply bronchography to the study of chest diseases of all types. During the first two years we performed 400 bronchographic examinations, an analysis of which is presented here. As we began to increase the scope of bronchography, it became apparent that the successful interpretation and usefulness of the procedure depended on obtaining complete visualization of the peripheral bronchioles as well as of the larger bronchi. With this strict criterion for a satisfactory bronchogram, we found that in approximately one-fourth of the examinations filling was incomplete and re-examination was required. It was felt, therefore, that a discussion of some of the problems encountered in attempts to obtain complete visualization might be worthwhile. All patients except children who were too young to co-operate were given preoperative medication and local anesthesia with 1 per cent Pontocaine. The opaque medium was introduced through an endotracheal catheter, the tip of which had been placed in the desired location under fluoroscopic visualization. The catheter was adjusted during the instillation of the medium in order to obtain uniform filling. Reasons for incomplete visualization of the bronchial tree were as follows: 1. Failure to use sufficient Dionosil. If complete filling is not obtained with the 20 c.c. of Dionosil supplied in one bottle, a portion of a second bottle should be used. The extent of filling is best checked by ob-serving the patient first on his side and then on his back, since in this latter position it is easier to determine if a portion of the posterior basal segment of the lower lobe or a portion of the apical segment of the upper lobe is incompletely filled. 2. Improper preparation of Dionosil. This medium is a suspension; it must be shaken thoroughly before use and must approximate body temperature. Otherwise it will remain in the major bronchi and not be dispersed satisfactorily by respiratory movement. 3. Broncho spasm. Patients with a history of asthma are particularly subject to bronchospasm. It may be so severe that the functioning segments are flooded immediately while the bronchi in other segments do not admit any of the medium.