Bronchographic Findings Research Articles

Chronic bronchitis and emphysema at bronchography: survey of diagnostic features obtained by reviewing 2,000 bronchograms.

The interest in bronchopulmonary diseases is gradually turning from pneumonia and tuberculosis—today amenable to treatment—to conditions such as chronic bronchitis and emphysema, which not only remain challenging therapeutic problems, obscure in etiology, but also seem to be increasing in frequency. That these conditions are of great importance is indicated by the high mortality due to “chronic bronchitis,” “pulmonary emphysema,” and “cor pulmonale,” as shown in countries where these entities are included in mortality statistics. Oswald (24) cites the yearly death rate from “chronic bronchitis” in England as 30,000, a rather astonishing figure, considering that the corresponding annual death rates for pneumonia, cancer, and tuberculosis are 21,000, 16,000, and 8,000, respectively. Although emphysema is usually recognizable on plain chest roentgenograms, most radiologists are hesitant to make the diagnosis of “chronic bronchitis” from such films. This latter diagnosis is possible on the basis of clear-cut objective bronchographic criteria; yet too little attention has been paid to the wide variety of the diagnostic features. Dilatation of the mucous glands, bronchiolectases, and some other bronchographic characteristics of bronchitis have been described in the American radiological literature. Mention of other findings is scarce. Considerably more information is found in the foreign literature (2, 8, 9, 10, 14, 16, 26, 27, 32, 33, 35). It is the purpose of this paper to draw attention to the manifold bronchographic features of chronic bronchitis and to illustrate these with radiographs selected from 2,000 bronchographic examinations performed in a five-year period by members of the Radiology Department at the Ohio State University Hospital. It is hoped that this study will be a further contribution toward better understanding and earlier recognition of objective roentgenographic criteria of chronic bronchitis. Bronchographic Findings The bronchographic criteria of chronic bronchitis range from quite minimal functional disturbances to irregularities so extensive and severe that differentiation from early bronchiectasis may be difficult. Quite commonly, a variety of changes, from mild bronchitis to bronchiectasis, will be found simultaneously on bronchograms of one patient. The clinical severity also varies from mildly symptomatic disease, which is more a nuisance than a threat, to severe disabling states. The following changes have been observed bronchographically in patients with chronic bronchitis and emphysema: Spasm, a functional disturbance, is not pathognomonic of chronic bronchitis. It may occur in vegetatively labile persons as an acute response to irritation by contrast material, particularly of the water-soluble type, or it may be caused by the mechanical irritation of the examination.

The Bronchographic Findings and the Function of the Lung

The Bronchographic Findings and the Function of the Lung

Bronchography in pulmonary tuberculosis

A description is given of an unselected series of sanatorium patients with active pulmonary tuberculosis, who had bilateral bronchography carried out. The radiological and bronchographic findings have been correlated and compared with the pathological appearances in resection specimens. Theories of the mechanism by which bronchiectasis is produced in pulmonary tuberculosis, the value of bronchography in the assessment of cases and the indications remaining for its use, are discussed.

The correlation of bronchoscopic and bronchographic findings in the middle lobe syndrome.

The correlation of bronchoscopic and bronchographic findings in the middle lobe syndrome.

Bronchiolectasis in chronic bronchitis.

Bronchiolectasis is a manifestation of chronic bronchitis characterized by saccular dilatation of the terminal bronchioles. The more proximal bronchi may or may not show radiological changes. Zorini and Pigorini (1) first recorded the condition as “larval bronchiectasis” in 1934; in 1951 they reported that they had a personal experience with 100 cases. They recorded the clinical picture as one of chronic bronchitis in which hemoptysis is a prominent symptom. The chest films were negative, but the bronchograms showed small clubshaped or rosary-shaped distal branches. In the single case recorded by these writers symptoms were progressive and surgery was without apparent benefit. Simon and Galbraith (2), in 1953, described the bronchographic findings in 90 patients with a clinical diagnosis of chronic bronchitis. The bronchographic observations consisted in dilatation, diverticulosis, and narrowing of the bronchi and pooling of the contrast medium in the terminal bronchioles. Peripheral pooling occurred in 2...

A Bronchographic Sign of Chronic Bronchitis

The diagnosis of bronchitis by the radiologist is usually based on the observation of increased irregular parenchymatous markings and emphysematous changes. This evaluation is essentially an impression founded on experience closely correlated with many long-term histories. We are presenting here an objective sign, apparently pathognomonic of bronchitis, which we believe will be of help in this difficult diagnostic problem. It consists in the bronchographic demonstration of the dilated mucous gland ducts lining the major bronchi. Though Sicard and Forestier (10) originated the present bronchographic technic in 1922, it remained for Morlock and Pinchin (6), in 1933, to report some of the bronchographic findings in chronic bronchitis. They described sacculations between the cartilaginous rings, most marked in the trachea, and “roundish patches of Lipiodol which appeared to be outside the bronchial tree.” The significance of glandular involvement of the bronchial mucosa was first described by Stutz (13) and soon thereafter beautifully illustrated in 2 cases reported by Stiller (12) in 1949. Fischer (2), in 1950, reported 5 additional cases, attributing his success to the use of a water-soluble medium. More recently Simon (11) and Gudbjerg (3) have reported other cases. The latter author demonstrated the glandular findings with oily contrast material. He felt that the low reported incidence of glandular involvement was due to a lack of appreciation of the significance of such changes rather than to the type of medium used. Simon in reviewing the bronchograms of a large number of bronchitic patients found glandular involvement in 50 per cent. Clinico-Pathological Aspects The clinical diagnosis of chronic bronchitis is essentially one of exclusion (5). The possibility can be seriously entertained after elimination of such entities as asthma, bronchiectasis, upper respiratory tract infectious foci, pulmonary abscesses, cystic disease, tuberculosis, pneumoconioses, left ventricular failure, aortic aneurysm, and carcinoma. The symptoms are cough, sputum, and dyspnea, and the condition is most commonly found in middle-aged males with a fairly strong family history (7). The pathophysiology of bronchitis can best be understood by a consideration of the effects of irritation on the bronchial mucosa. In response to a variety of noxious agents there is an increased production of mucus. This excess mucus was microscopically demonstrated by Reid (8, 9) to be due to a hypertrophy of the mucus-secreting elements. Large numbers of goblet cells were also noted in the bronchioles, where they are normally scarce. Other early microscopic findings are dilatation of the mucous gland ducts (this being responsible for the bronchographic findings described below), edema, and round-cell infiltration of the physiologically weakened bronchial wall.

Changes in Bronchographic Findings before and after Collapse Therapy

Changes in Bronchographic Findings before and after Collapse Therapy

A clinical survey of Bronchiectasis

A report is presented of 35 cases of bronchiectasis and a second group of 78 patients whose clinical symptoms or plain skiagram suggested the presence of this disease. An enquiry is made into the aetio-logical factors in this condition with special reference to (a) attacks of measles, whooping cough and pneumonia before adolescence, (b) intimate exposure during infancy or childhood by an adult bronchitic source of infection. An analysis of 1,000 consecutive cases of haemoptysis, in 18 per cent of which no aetiological factor was discovered. A note on the equivocal nature of the clinical signs in bronchiectasis. The importance of abnormalities in the anatomy of the pulmonary vascular tree, cardiac outline, etc., in the diagnosis of bronchiectasis from the plain skiagram. Tabulation of the bronchographic findings in 35 cases of bronchiectasis. An expression of opinion that the expectation of life and moderate health in this disease is less gloomy than is generally accepted.