Bronchoscopy and Bronchography in Emphysema and Chronic Bronchitis

Demonstration of Morphologic Changes in an Attempt at Appraisal of Severity of Functional Impairment

¹ Medical and Surgical Departments and the Pulmonary Laboratory, Church Home and Hospital

An attempt is made to review briefly certain morphologic features of chronic bronchitis and pulmonary emphysema as they appear on bronchoscopic view and on bronchographic films. The frequency of endoscopic visualization of dilated bronchial gland openings occurring in 33.6 per cent of 315 consecutive bronchoscopies is emphasized. As a rule, the dilated glands may be demonstrated in 90 per cent of corresponding subsequent bronchograms. This evidence of present or past instances of chronic bronchitis is observed in conjunction with a multitude of unusual bronchographic findings, the more severe of which add up to what properly should be termed chronic deforming bronchitis. The transition to true bronchiolectasis or to diffuse bronchiectasis is demonstrated. A bizarre finding of pooling frequently seen in bornchograms of emphysema cases is briefly correlated with the most recent concepts of the pathology of emphysema. There is a suggestion that the size of the peripheral pools is directly proportionate to the extent of emphysema, and that reversibility of impaired pulmonary function can only be hoped for in those cases showing minimal and minute pooling collections. Finally, in single bullous cysts the value of bronchography in demonstrating bronchial position and displacement is emphasized.