Bronchography: Summary of a World-Wide Survey Report of Committee on Broncho-Esophagology

The participants in this study and the members of the Committee on Broncho-esophagology consider bronchography to be an important diagnostic aid. Bronchography should be done by physicians with training and experience who are willing to take the time to do it well. It should not be delegated to the inexperienced intern or resident. Too often bronchography is treated as a "stepchild." If bronchography is worth doing at all, it should be done well.

No longer do we think of bronchography as merely a means of confirming a diagnosis of bronchiectasis already suspected or as a roentgenoscopic demonstration of an obstruction already seen through the bronchoscope. Today the thoracic surgeon requests precise information as to the segments involved in bronchiectasis of tuberculosis, and above all he wants to know which bronchi are normal. In segmental resection of the lung the results may be disastrous if this information is not available to the surgeon. Thus complete bilateral bronchography is essential.

Even the most experienced bronchographer does not claim more than 90 per cent success in obtaining adequate bronchograms, and in less capable hands the number of poor bronchograms is considerable. Hence, it is obvious that there is plenty of room for improvement in the technic of bronchography. Good anesthesia is essential but the agent must be administered within the limits of safety. We are still searching for the perfect contrast medium and present technics can certainly be improved. Bronchography in children deserves particular attention, both with respect to selection of patients and to performance of the procedure. Of prime importance is the maintenance of an airway for the administration of oxygen. At present it would seem that both an intratracheal tube and a catheter should be passed into the trachea so that oxygen can be given before, during and after the instillation of the contrast substance.

Interpretation of bronchograms requires a thorough knowledge of bronchial anatomy and the common bronchial variations. Considerable experience is essential for the reading of bronchograms, and interpretation should be correlated with the clinical problem as well as other roentgenographic studies of the thorax. Bronchospasm, retained secretions and recent pneumonitis or atelectasis may profoundly alter the bronchographic pattern. Too often an opinion is expressed on an inadequate bronchogram.

Much remains to be learned about the physiology of the bronchial tree. A good deal of information can be obtained by motion pictures of the fluoroscopic image of the bronchial tree filled with contrast medium. Up to the time of this report such technics have been impractical because of the radiation hazard. It is hoped that with improvements in imageamplifier equipment, the bronchial tree can be studied in action. Hence, it is possible that bronchography will make a contribution to our knowledge of pulmonary physiology as it already has to bronchial anatomy.