Bronchography was performed together with a fibre-optic bronchoscopic study in 98 patients with persistent cough, 33 of whom also had haemoptysis. Finally there were chronic bronchitis in 62 patients, bronchiectasis in 21, subacute bronchitis in 9, inflammatory residuals in 3, pulmonary tuberculosis in 2 patients and metastases in one. In chronic bronchitis, the value of plain chest radiography was low. It was normal in 34 of 62 cases (55%), bronchography in 12 cases (19%). Mild cases of bronchitis were more numerous in bronchography than seen by scopist. Bronchiectasis was found in 21 patients, four of these unexpectedly (two in a tbc scar). Additionally, three cases were overdiagnosed by the radiologist on chest films and eight cases by the scopist with bronchoscopy. In patients with persistent cough and haemoptysis, bronchography mainly revealed alterations of bronchitis. (orig.)
De Bernardo, Giuseppe; Sordino, Desiree; Giordano, Maurizio; Doglioni, Nicoletta; Trevisanuto, Daniele
Esophageal atresia (EA) with tracheoesophageal fistula occurs in about 1:2,500 births. We report a case of persistent bronchography in a newborn with EA and distal tracheoesophageal fistula. A large amount of barium sulfate was injected for mistake by a tube directly in the right bronchus to evaluate the patency of the esophagus. The infant showed signs of respiratory distress; he was intubated and transported at children's Hospital Santobono Pausilipon. Here, it was performed a chest X-ray that confirmed the opacification of the right bronchial tree, and it was suspected an EA type 3b. The literature recommends that: evaluation of the patency of the esophagus, with an iodinate contrast medium, should be done in a pediatric specialized center for high risk of lung aspiration. PMID:27257464
Giuseppe De Bernardo, MD
Full Text Available Esophageal atresia (EA with tracheoesophageal fistula occurs in about 1:2,500 births. We report a case of persistent bronchography in a newborn with EA and distal tracheoesophageal fistula. A large amount of barium sulfate was injected for mistake by a tube directly in the right bronchus to evaluate the patency of the esophagus. The infant showed signs of respiratory distress; he was intubated and transported at children's Hospital Santobono Pausilipon. Here, it was performed a chest X-ray that confirmed the opacification of the right bronchial tree, and it was suspected an EA type 3b. The literature recommends that: evaluation of the patency of the esophagus, with an iodinate contrast medium, should be done in a pediatric specialized center for high risk of lung aspiration.
Bronchography has been performed on 154 patients, having the infectious-allergic form of bronchial asthma. Pathologic changes on the bronchograms have been detected in 99 (64.3 %) patients. Deforming bronchitis, characterized by the different degree of manifestness and stretch, has been more frequent (49.3%), while bronchoectases (14.3%) and cirrhosis (0.7%) have been rarer findings
Ventilatory disorders have been studied in 187 patients by means of X-ray examination of the respiratory tract and its functional changes with the help of improved method of aspiration bronchography. The data obtained permit to distinguish the causes of ventilatory function disorders (obstructive and restrictive alterations) and the process spreading (diffuse or regional character). Timely detection of these lesions could help to avoid undesirable consequences in the treatment of patients
Garcia Aguayo, F.J.; Calpe, J.L.; Chiner, E.
Diagnosis of round atelectasis (RA) has been carried out in five patients with simple radiography (SR) and linear tomography (LT). These procedures showed in all patients curved bronchovascular parcel towards pseudotumor, main diagnosis criterior. Computed tomography effectiveness was less than SR and LT, but revealed bilateral lesion in patient and moreover, shape, size and relations of RA with pleura. CT also showed in a patient AR development from effusion of slow resolution, corroborating pathogenic hypothesis of Hanke. In four cases bronchography was performed, confirming curvature and bronchial penetration in AR. (Author)
Honnef, Dagmar; Wildberger, Joachim E.; Das, Marco; Hohl, Christian; Mahnken, Andreas H.; Guenther, Rolf W.; Staatz, Gundula [University Hospital RWTH Aachen, Department of Diagnostic Radiology, Aachen (Germany); Barker, Michael [University Hospital RWTH Aachen, Department of Pediatrics, Aachen (Germany)
To evaluate the value of dose-reduced 16-slice multidetector-row spiral computed tomography (16-MDCT) using virtual tracheobronchoscopy (VTB) and virtual bronchography (VBG) in children with suspected tracheobronchial stenosis. 12 children (4 d to 3 years, body weight 1.2 kg to 13.5 kg) with stridor and suspected tracheobronchial stenosis were examined by contrast-enhanced low-dose 16-MDCT. Conventional axial slices, MPRs, VTB, and VBG were calculated. Image findings were correlated with the results of fiberoptic bronchoscopy (12 out of 12) as a gold standard and subsequent surgery (8 out of 12). VTB and VBG demonstrated the fiberoptic bronchoscopically suspected tracheal stenosis in 11 of 12 children due to vascular compression because of the brachiocephalic trunk (6), a double aortic arch (2), a vascular compression of the left main bronchus (2), and a right aberrant subclavian artery (1). Eleven out of 12 stenoses were correctly depicted by conventional axial slices, MPRs, VTB, and VBG. Dose reduction was 79 to 85.8% compared to a standard adult chest CT. Dose-reduced 16-MDCT with the use of VTB and VBG is effective for the evaluation of tracheobronchial stenosis in children and correlates well with fiberoptic bronchoscopy. (orig.)
Two solutions of barium sulphate, 60 and 30% w/v, were compared with the ''overflow'' Bronchographic method. Two groups of eight healthy adult does of both sexes, weighing 7 to 18 kg were used for the study. The dogs were anaesthetised with thiopentone sodium 2% (20 mg/kg iv). After intubation, each dog received contrast medium by a catheter connected to a syringe, in a 9 mi dose. Two series of two x-rays plates were taken in left lateral recumbent, 3 and 6 min after administering the contrast medium and in ventrodorsal projection, 30 sec. later. The x-ray plates obtained were analysed and compared intra and inter group considering the advance speed of the contrast medium, the radiographic density and outlines. Adverse reactions were controlled
Full Text Available Con el fin de comparar dos concentraciones de sulfato debario, 60 y 30% pv, mediante el método broncográfico "dederrame", se trabajó con dos grupos de 8 perros adultos, de ambossexos, clínicamente sanos, de 7 a 18 kg de peso, anestesiados contiopental sódico (2% en dosis de 20 mg/kg vía iv. El mediode contraste se aplicó previa intubación del paciente, conun catéter conectado a una jeringa en dosis de 9 ml para cada perro.Se tomaron dos series radiográficas por animal, a los 3 y 6 minde aplicado el medio de contraste, en proyección lateral izquierday luego ventrodorsal 30 seg después. Las radiografías obtenidasfueron analizadas y comparadas intra e intergrupo, considerando la velocidadde avance del medio de contraste, densidad y contorno radiográfico,así como la presentación de reacciones adversas. Los resultadosindican que la velocidad de avance fue mayor con la concentraciónal 30%, ya que alcanzó a los 3 min en ambas proyecciones las estructurasanatómicas terminales del árbol bronquial, provocando alveolarizacióndel medio de contraste, lo que aumentó a los 6 min. Por esto seconsideró más adecuada la concentración al 60% yaque avanza hasta los bronquios, sin alcanzar el nivel alveolar. La densidadradiográfica media predominó en los diferentes segmentosen ambas concentraciones, presentándose en mayor proporciónpara la concentración al 60% la densidad media a alta, y para laconcentración al 30% la densidad media a baja. El contorno radiográficodel árbol bronquial se observó mayoritariamente liso conla concentración al 60%, en ambos tiempos para ambas proyecciones.En la concentración al 30% los contornos irregulares se presentaronen similar proporción que los contornos lisos en ambas series radiográficas.No se registró reacción adversa posterior a la realizacióndel método broncográficoTwo solutions of barium sulphate, 60 and 30% w/v, were compared with the "overflow" Bronchographic method. Two groups of eight healthy adult dogs of both sexes, weighing 7 to 18 kg were used for the study. The dogs were anaesthetised with thiopentone sodium 2% (20 mg/kg iv. After intubation, each dog received contrast medium by a catheter connected to a syringe, in a 9 ml dose. Two series of two x-rays plates were taken in left lateral recumbent, 3 and 6 min after administering the contrast medium and in ventrodorsal projection, 30 sec. later. The x-ray plates obtained were analysed and compared intra and inter group considering the advance speed of the contrast medium, the radiographic density and outlines. Adverse reactions were controlled
Roentgenologic semiotics of acute and chronic bronchites has been presented. It is shown, that in the combined daignosis of bronchi diseases roentgenograp hy and roentgenoscopy of lungs, roentgenofunctional tests and bronchography shou ld be used. For the diagnosis of broncholithiases, retention cysts and foreign bodies in bronchi the tomography, bronchography and bronchoscopy are used
Method of diagnosis of chronic nonspecific diseases of lungs in children using bronchography and arteriography is suggested to improve diagnosis accuracy. The method lies in simultaneous contrasting of all bronchial arteries of both lungs. The suggested method of diagnosis enabled to obtain data on pathology of bronchial arteries and bronchial structurs, to reveal additional information about propogation and character of pathologic process
Four chosen examples of infant bronchi stenoses are described after a review of the patient collective. The etiology and the radiological signs and symptoms of bronchi stenoses in infant age are discussed. The prerequisites for bronchography in infants are discussed. (orig.)
The book on diagnostic radiology of thoracic diseases covers the following topics: diagnostic techniques and normal diagnostic findings using x-ray radiography, CT, scintigraphy, angiography, bronchography, ultrasonography and NMR imaging; malformations; infections; emphysema, chronic lung diseases and asthma; inhalation damage and pneumoconiosis; neoplasm; vascular diseases; thorax injuries, pleura diseases, heart diseases, mediastinum diseases; midriff diseases; thoracic wall diseases; pathological pattern in CT; radiological indications and differential diagnostics; thoracic interventions.
Baden, W; Schaefer, J; Kumpf, M; Tzaribachev, N; Pantalitschka, T; Koitschev, A; Ziemer, G; Fuchs, J; Hofbeck, M
Bridging bronchus (BB) is a rare, congenital bronchial anomaly that is frequently associated with congenital cardiac malformations, especially left pulmonary artery sling. It represents an anomalous bronchus to the right originating from the left main bronchus. Discrimination from other bronchial anomalies is important, since BB is frequently associated with bronchial stenoses due to abnormal cartilage rings. This case study describes the findings of bronchoscopy, bronchography and multidetector computed tomography (MDCT) in three patients. Bronchoscopy was helpful in the description of the severity and length of bronchial stenoses. However, it was not possible to establish a diagnosis of BB based on this method in two patients, since it is difficult or even impossible to differentiate the bifurcation from the pseudocarina. It was not possible to establish the correct diagnosis in all patients based on bronchography or MDCT. MDCT was able to depict the relationship of bronchial and vascular structures, which is particularly important in patients with pulmonary artery sling. Multidetector computed tomography is preferable to bronchography as it is less invasive and due to its short acquisition time it can be performed in children with severe respiratory disease. In the current authors' experience, detection of cartilage rings still requires flexible bronchoscopy. PMID:18448507
A six-year-old girl presented with Mycoplasma pneumoniae involving the right upper and lower lobes. She made a slow but complete recovery with resolution of the radiological changes. She represented 5 years later with a productive cough, recurrent wheezing and physical and radiological signs suggestive of obliterative bronchiolitis. This diagnosis was confirmed by ventilation - perfusion (dV/dt/dQ/dt) lung scan, and bronchography. The case highlights the value of dV/dt/dQ/dt scanning in the diagnosis of obliterative bronchiolitis and confirms the previous reports that mycoplasma infections are not always benign. (orig.)
Bykova, Iu; Weinhardt, V; Kashkarova, A; Lebedev, S; Baumbach, T; Pichugin, V; Zaitsev, K; Khlusov, I
The applications of synchrotron radiation (SR) in medical imaging have become of great use, particularly in angiography, bronchography, mammography, computed tomography, and X-ray microscopy. Thanks to recently developed phase contrast imaging techniques non-destructive preclinical testing of low absorbing materials such as polymers has become possible. The focus of the present work is characterization and examination of UHMWPE-derived materials widely used in medicine, before and after their exposure to SR during such testing. Physical properties, such as wettability, surface energy, IR-spectroscopy, roughness, optical microscopy, microhardness measurements of UHMWPE samples were studied before and after SR. The relationship between a growth of UHMWPE surface hydrophilicity after SR and surface colonization by stromal cells was studied in vitro. Obtained results demonstrate that SR may be used as prospective direction to examine bulk (porous) structure of polymer materials and/or to modify polymer surface and volume for tissue engineering.
Puylaert, Carl B A J; Puylaert, Julien B C M
If a radiologist from 1950 could travel in time to 2011, he or she would be baffled to see how few of the radiological examinations he was familiar with, remain. We review the radiological examinations that have disappeared since X-rays were discovered, and include the causes of their disappearance. Barium studies have mainly been replaced by endoscopy, oral cholecystography by ultrasound, and intravenous urography by CT-scan. Angiography by means of a direct puncture of carotid artery and aorta has been replaced by Seldinger angiography. Pneumencephalography and myelography have been replaced by CT and MRI. Bronchography has been replaced by bronchoscopy and CT-scan, arthrography by MRI and arthroscopy. Many other radiological examinations have been replaced by ultrasound, CT or MRI. PMID:21447222
Hegenbarth, R.; von der Hardt, H.; Zimmermann, H.
The article discusses the X-ray signs seen in 14 babies with unilateral emphysematous expansion. 7 of these infants had a lobar emphysema without any defect of the bronchial cartilage, whereas two had pulmonary cysts, one suffered from a congenital cystic adenomatoid pulmonary malformation, and one infant had been suffering from lymphangiectasy; in all cases, successful lobectomy had been performed. One patient with pneumatocele, one with a left-side agenesia of the upper lobe and one with a transient obstruction of the bronchi by a mucous plug, were given conservative treatment. The article discusses the X-ray differentiation of the following disturbances: pneumothorax, diaphragmatic hernia, compensatory and obstructive emphysematous expansion of a pulmonary lobe, cystic changes in the lung, and lobar emphysema, although this does not offer any possibility of discovering the reason for its occurrence. Attention is drawn to the diagnostic value of bronchoscopy and bronchography, as well as angiography, especially in case of suspected vascular malformation.
Pulmonary abnormalities in cystic fibrosis result from the obstruction of small bronchi by highly viscous mucus. Chronic obstructive lung disease and recurrent pulmonary infections result in a typical radiographic pattern later in the disease. Most patients can now be expected to survive into adulthood. The radiologist must make a careful comparison of serial films in order to detect complications early. By far the most important imaging modality is the conventional chest radiograph. CT is more sensitive for detection of structural abnormalities of the lung. Bronchography is a dangerous procedure and can lead to rapid deterioration of lung function. Lung scanning is a very sensitive method for demonstrating regional disturbances of ventilation and may reveal abnormalities earlier than conventional radiographs. In severe hemoptysis, selective bronchial arteriography with embolization of the bleeding vessel can be a life-saving procedure. (orig.)
Early or slight chronic pulmonary emphysema (CPE) may be difficult to diagnose. Therefore, this study examined local and overall lung CT densities, pulmonary function, and clinical features in 15 patients with selective alveolo-bronchography-proven CPE and 9 healthy volunteers to establish the method for diagnosing CPE early. Selective alveolo-bronchography revealed a ring shadow of 900 μm or more in all patients. CT densities in the whole lung, and all of the upper, horizontal middle, lower, anterior, frontal middle, and posterior regions were significantly lower in the CPE group than the control group. Mean CT density in the upper region was significantly lower than in the lower region in the CPE group, although there was no difference in CT densities between the upper and lower regions in the control group. In the control group, mean CT density in the anterior region was significantly lower than in the posterior region. Mean values of FVC, %FVC, FFV1.0, FFV1.0%, PEF, and V50/V25 were significantly decreased in the CPE group. Mean lung CT densities were capable of detecting CPE in 12 patients. There was significant correlation between mean CT densities and both FEV1.0% and PEF. The discrepancy in CT density between the upper and lower regions showed a positive correlation to V50/V25. According to clinical features, patients having persistent cough and sputum had a larger diameter of ring shadow and a great difference in CT density between the upper and lower regions than those having dyspnea. The existence of both cough and sputum seemed to be associated with inhomogeneously destroyed alveoli. In conclusion, when FEV1.0% of 55%-80% and V50/V25 of 3.2 or more are seen in patients with chronic obstructive pulmonary disease or cigarette smokers aged 40 years or over, and when CT reveals mean lung density of -912 H.U. or less or the difference of 23 H.U. or more in the upper and lower regions, emphysema can be diagnosed clinically. (N.K.)
The term unilateral hypoperfusion lung (UHL) is here used to indicate decreased unilateral activity of the lung as determined in the lung perfusion scintigram. The same condition has been referred to by other authors as absent perfusion of one lung, unilateral absence of pulmonary artery perfusion, total lack of pulmonary artery perfusion of one lung, bloodless lung, decreased unilateral perfusion of the lung, unilateral pulmonary hypoperfusion, nonperfusion of one lung and absence of radioactivity over one lung. We studied 59 cases of UHL, including pulmonary carcinoma, bronchial foreign body, hypo- or a-plasia of the lung or pulmonary artery, unilateral pleural effusion, post-operative and Swyer-James syndrome. Using scintigram, UHL was found even where slight or no abnormalities showed up on plain x-ray film, and the finding of UHL was especially useful to evaluate blood flow in the lucent or hyperlucent lung. Scintigraphic and pulmonary arteriogram findings corresponded. Bronchography or ventilation scintigraphy with 133Xe gas was also performed in some cases, and this additional ventilation study was effective in advanced diagnosis of chest diseases. On the other hand, ''Gamut'' which indicates a complete list of causes of a particular x-ray finding is available in the differential diagnosis or resident training. In a field of nuclear medicine, a gamut approach had also begun to be applied recently, so UHL was evaluated at this point of view. (author)
Full Text Available Thoracoscopic segmentectomy is technically much more meticulous than lobectomy, due to the complicated anotomical variations of segmental bronchi and vessels. Preoperative three-dimensional computed tomography bronchography and angiography, 3D-CTBA could reveal the anatomical structures and variations of the segmental bronchi/vessels and locate the pulmonary nodules, which is helpful for surgery planning. Preoperative nodule localization is of vital importance for thoracoscopic segmentectomy. Techniques involved in this procedure include dissection of the targeted arteries, bronchus and intra-segmental veins, retention of the inter-segmental veins, identification of the inter-segmental boarder with the inflation-deflation method and seperation of intra-segmental pulmonary tissues by electrotome and/or endoscopic staplers. The incision margin for malignant nodules should be at least 2 cm or the diameter of the tumor. Meanwhile, sampling of N1 and N2 station lymph nodes and intraoperative frozen section is also necessary. The complication rate of thoracoscopic segmentectomy is comparatively low. The anatomic relationship between pulmonary segments and lobes is that a lobe consists of several irregular cone-shaped segments with the inter-segmental veins lies between the segments. Our center has explored a method to separate pulmonary segments from the lobe on the basis of cone-shaped principle, and we named it “Cone-shaped Segmentectomy”. This technique could precisely decide and dissect the targeted bronchi and vessels, and anatomically separate the inter-segmental boarder, which ultimately achieve a completely anatomical segmentectomy.
Torsion or volvulus of the lung is a relatively rare but serious condition that can often be recognized or at least suspected radiographically. It occurs under three different sets of circumstances: spontaneously, usually in association with some other pulmonary abnormality; with traumatic pneumothorax; and as a complication of thoracic surgery. The author studied nine cases of torsion of the lung, including examples from each of these categories. The radiographic signs of torsion are as follows: a collapsed or consolidated lobe that occupies an unusual position, hilar displacement in a direction inappropriate for an apparently collapsed lobe, alteration of the normal position and sweep of the pulmonary vasculature, raid opacification of an ipsilateral lobe after trauma or lobectomy, marked change in position of an opacified lobe on sequential films, bronchial cutoff with no evidence of a mass, abnormal position of an affected lobe (shown on CT, angiography, or bronchography), and lobar air trapping. Mortality is high if the torsion goes unrecognized and operation is delayed
Dabin, Y.; Draperi, A.; Elleaume, H.; Charvet, A.-M.; Brochard, T.; Perez, M.; Nemoz, C.; Blattmann, G.; Renier, M.; Fournier, F.; Dupuy, J.-L.; Lemoine, B.; Bouhaniche, P.; Thomlinson, W.; Suortti, P.
The medical imaging facility of the ESRF is devoted to human coronary angiography, computed tomography, diffraction enhanced imaging (DEI), bronchography, and also radiation therapy programs. Most of the imaging is performed in a satellite building located at 150 m from the wiggler source (H. Elleaume et al., Nucl. Instr. and Meth. A 428 (1999) 513). A multi-purpose device known as the Patient Positioning System (PPS or medical chair) has been designed to perform in different modes of research on patients. This device operates in the angiography mode, with alternating up and down movements in 1.6 s cycles over a period of about 30 s. The tomography mode is used mainly for the imaging of the brain. It consists of turning the patient around an axis perfectly perpendicular to the beam plane. A dual-energy scan involves two rotations with one image recorded each turn at a different energy (Phys. Med. Biol. 45 (2000) L39). The first angiography imaging on patients was undertaken in January 2000 after successful pre-clinical tests on animals.
The medical imaging facility of the ESRF is devoted to human coronary angiography, computed tomography, diffraction enhanced imaging (DEI), bronchography, and also radiation therapy programs. Most of the imaging is performed in a satellite building located at 150 m from the wiggler source (H. Elleaume et al., Nucl. Instr. and Meth. A 428 (1999) 513). A multi-purpose device known as the Patient Positioning System (PPS or medical chair) has been designed to perform in different modes of research on patients. This device operates in the angiography mode, with alternating up and down movements in 1.6 s cycles over a period of about 30 s. The tomography mode is used mainly for the imaging of the brain. It consists of turning the patient around an axis perfectly perpendicular to the beam plane. A dual-energy scan involves two rotations with one image recorded each turn at a different energy (Phys. Med. Biol. 45 (2000) L39). The first angiography imaging on patients was undertaken in January 2000 after successful pre-clinical tests on animals
Gaillard, E.A. E-mail: firstname.lastname@example.org; Carty, H.; Heaf, D.; Smyth, R.L
Introduction: bronchiectasis is generally considered irreversible in the adult population, largely based on studies employing bronchography in cases with a significant clinical history. It is assumed, that the same is true for children. Few studies have examined the natural history of bronchiectasis in children and diagnostic criteria on high-resolution computer tomography of the lungs are derived from studies on adults. Frequently, bronchiectasis is reported in children in cases where localised bronchial dilatation is present, incorrectly labelling these children with an irreversible life-long condition. Objective: to evaluate changes in appearance of bronchial dilatation, unrelated to cystic fibrosis in children, as assessed by sequential high-resolution computer tomography (HRCT) of the lungs. Methods: the scans of 22 children with a radiological diagnosis of bronchiectasis, seen at Alder Hey Children's Hospital between 1994 and 2000, who had at least two CT scans of the lungs were reviewed by a single radiologist, who was blinded to the original report. Results: following a median scan interval of 21 months (range 2-43), bronchial dilatation resolved completely in six children and there was improvement in appearances in a further eight, with medical treatment alone. Discussion: a radiological diagnosis of bronchiectasis should be considered with caution in children as diagnostic criteria derived from studies in adults have not been validated in children and the condition is generally considered irreversible.
Grenier, Philippe A.; Beigelman-Aubry, Catherine [Department of Radiology, University Pierre et Marie Curie, Paris (France); Fetita, Catalin; Preteux, Francoise [Institut National des Telecommunications, Department ARTEMIS, Evry (France); Brauner, Michel W. [Avicenne Hospital, UFR SMBH Paris XIII, Bobigny (France); Lenoir, Stephane [Institut Mutualiste Montsouris, Paris (France)
Combining helical volumetric CT acquisition and thin-slice thickness during breath hold provides an accurate assessment of both focal and diffuse airway diseases. With multiple detector rows, compared with single-slice helical CT, multislice CT can cover a greater volume, during a simple breath hold, and with better longitudinal and in-plane spatial resolution and improved temporal resolution. The result in data set allows the generation of superior multiplanar and 3D images of the airways, including those obtained from techniques developed specifically for airway imaging, such as virtual bronchography and virtual bronchoscopy. Complementary CT evaluation at suspended or continuous full expiration is mandatory to detect air trapping that is a key finding for depicting an obstruction on the small airways. Indications for CT evaluation of the airways include: (a) detection of endobronchial lesions in patients with an unexplained hemoptysis; (b) evaluation of extent of tracheobronchial stenosis for planning treatment and follow-up; (c) detection of congenital airway anomalies revealed by hemoptysis or recurrent infection; (d) detection of postinfectious or postoperative airway fistula or dehiscence; and (e) diagnosis and assessment of extent of bronchiectasis and small airway disease. Improvement in image analysis technique and the use of spirometrically control of lung volume acquisition have made possible accurate and reproducible quantitative assessment of airway wall and lumen areas and lung density. This contributes to better insights in physiopathology of obstructive lung disease, particularly in chronic obstructive pulmonary disease and asthma. (orig.)
Krypton 81m ventilation and technetium 99m perfusion lung scans in anterior, posterior and oblique views in 86 children (age range 14 days to 15 years) with various paediatric problems were obtained. Four main areas of clinical usefulness were found: (a) Establishing the diagnosis; in a relatively small number of patients the lung scan was essential for establishing the exact diagnosis or directing attention to the abnormal area. (b) Refuting a diagnosis: the two main groups in this category include possible bronchiectasis and inhaled foreign body. (c) Radionuclide studies enable one to assess and follow up the extent of the disease in children with lower respiratory problems; a lung scan may obviate the need for bronchography in bronchiectatics failing to respond to medical treatment and for whom surgery is being considered. Repeat studies are useful in following the natural history or the response to treatment of various lung conditions. (d) Assessing the success of surgical procedures on the heart and on abnormal pulmonary arteries. 81Krsup(m) ventilation/99Tcsup(m) perfusion scanning were particularly useful in small children in whom tests of overall pulmonary function could not be carried out because of lack of co-operation. (author)
Shin, Ji Hoon; Song, Ho-Young; Kim, Kyung-Rae; Kim, Jin Hyoung (Dept. of Radiology and Research Inst. of Radiology, Univ. of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea)); Kim, Sang Wee; Lee, Dae-Ho; Hong, Sang-Beom (Internal Medicine, Univ. of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea))
Background: Location of tumor within the tracheobronchial tree as well as its severity can affect the clinical outcome of patients who undergo airway stent placement. Purpose: To evaluate radiologic and clinical outcome, including survival data, with special reference to proposed tumor involvement pattern, in patients with malignant bronchial strictures. Material and Methods: A total of 35 patients who underwent stent placement for malignant bronchial strictures were enrolled over a 9-year period. Tumor involvement pattern was divided into three types based on computed tomography (CT) scans and selective bronchography. Type I was defined as tumor involving only the main stem bronchus; type II, tumor involving the bronchus intermedius and/or the lower lobar bronchus without involvement of the lower-lobe segmental bronchus; and type III, tumor involving the lower lobar bronchus with involvement of the lower-lobe segmental bronchus. Tumor stage, lung collapse/infiltration, radiologic improvement, clinical improvement, and survival were compared according to the tumor involvement pattern. Results: Tumor involvement pattern was of type I, II, and III in 14, 13, and eight patients, respectively. When comparisons were made between types I/II and type III to evaluate the influence of lower-lobe segmental bronchial involvement, radiologic and clinical improvement was significantly lower in type III than in types I/II, while advanced stage, lung collapse/infiltration, and median overall survival were not significantly different between types I/II and type III. Conclusion: In patients with malignant bronchial obstructions involving the lower-lobe segmental bronchus, clinicians must be aware of the possibility of less radiologic and clinical improvement following stent placement
唐琦峰; 钱燕宁; 张洪兴
目的:研究静脉注射利多卡因对芬太尼诱导的咳嗽反应的影响.方法:择期行全麻手术病人60例,随机分为3组,Ⅰ组在芬太尼注射前1分钟静脉注射利多卡因(1mg/kg),Ⅱ组在芬太尼注射前1分钟静脉注射利多卡因(2mg/kg),Ⅲ组为对照组.分别观察芬太尼注射后的咳嗽反射情况,咳嗽1-2次为轻微,3-4次为中等,5次以上为重度.结果:Ⅰ组、Ⅱ组和Ⅲ组咳嗽反应的发生率为分别为25%、30%和65%,Ⅰ组、Ⅱ组咳嗽反应的发生率明显低于Ⅲ组(P＜0.05),Ⅰ组和Ⅱ组比较无明显差别(P＞0.05).结论:芬太尼注射前1分钟静脉注射利多卡因1mg或2mg可有效减轻芬太尼诱导的咳嗽反射;芬太尼注射前1分钟静脉注射利多卡因的量对减轻芬太尼诱导的咳嗽反射区别不大.%Fentanyl is commonly used as a pre-induction adjunct because of its quick onset,short duration of action,intense analgesia,and cardiovascular stability,but a pre-induction bolus dose of fentanyl elicits cough.Fentanyl-induced cough is common but has not been viewed as a serious anesthetic problem.Intravenous lidocaine suppresses the cough reflex during endotracheal intubation,extubation,bronchography,bronchoscopy and laryngoscopy[1-3].It has been found effective when given intravenously to suppress the cough reflex of endotracheal intubation and cough induced by manual displacement of the endotracheal tube and instillation of distilled water into the trachea in anesthetized patients.We evaluated the different dose of lidocaine for suppression of fentanyl-induced cough in this randomized,prospective and placebo-controlled study.
There are many pathogenetic factors for collapse of right middle lobe; profuse peribronchial clustering of lymph nodes about the right middle lobe bronchus, poor drainage of the bronchus because of its acute angle of take-off from the intermediate bronchus, and the isolation of this small lobe from the right upper and lower lobes, and thus from the aerating effects of collateral ventilation. Retrospectively we reviewed 36 cases of right of right middle lobe collapse of which causes were confirmed by histopathologic or bronchographic findings during the recent 6 years from March 1983 to February 1988 at Inje College Pusan Paik Hospital, and obtained the following results: 1. Male to female ratio was 1:1:4,and peak incidence (64%) was in the fifth and sixth decades with the mean age of 51.1 years. 2. Bronchiectasis was the most common cause (30.6%), and the others were chronic bronchitis (25.0%), pulmonary tuberculosis (19.4%), lung cancer (16.7%), and non-specific inflammatory disease (8.3%). This suggests benign disease is 5 times more common cause of right middle lobe collapse than lung cancer. 3. Among the plain chest radiolograph findings, obliteration of right cardiac border and triangular radiopaque density were the most frequent findings(77.8% in each) and the next was downward and anterior displacement of minor and major fissures (55.6%) 4. Bronchography was done in 11 cases; bronchiectasis was found in 8 cases and chronic bronchitis in 3 cases. Right middle lobe bronchus was obstructed in 2 cases of chronic bronchitis. 5. Chest CT scan was performed in 4 cases of lung cancer, 2 of non-specific inflammatory disease, and 1 of pulmonary tuberculosis: all of lung cancer revealed hilar mass, budged or lobulated fissures, in homogenous density, and mediastinal lymph node enlargement, and all benign disease showed homogenous density and flat to concave fissures. Right middle lobar bronchus narrowing was seen in 5 cases and its obstruction in 2 cases
OLAVO RIBEIRO RODRIGUES
-up was observed a total regression of the bilioptysis and disappearance of the jaundice after the seventh postoperative day. The patient was submitted to bronchography that did not reveal anatomical changes on the right lowers bronchi by biliary flood. The patient is on the seventh postoperative year without any evidence of the disease.
Ettorre, G.C.; Francioso, G.; Fracella, M.R.; Strada, A.; Rizzo, A. [Bari Univ., Bari (Italy). Dipt. di Medicina Interna e Medicina Pubblica, Sezione Diagnostica per Immagini
The diagnosis of pulmonary sequestration is based on demonstration of mal developed lung tissue, feeding on abnormal systemic level. It has been investigated the role of angiography in the diagnosis of pulmonary sequestration in adult patients. 1987 to 1998 it was examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra- versus intralobar sequestration. Therefore it can be concluded that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography. [Italian] Scopo di questo lavoro e' presentare la diagnosi di sequestro polmonare che si basa sulla dimostrazione di tessuto polmonare displasico irrorato da un vaso anomalo d'origine sistemica. Si riporta il ruolo sostenuto dall'angiografia nella diagnosi e nell'inquadramento nosologico di tale malattia nei soggetti adulti. Dal 1987 al 1998, sono stati osservati con il sospetto di sequestro polmonare e successivamente sottoposti a intervento chirurgico 9 pazienti, 3 femmine e 6 maschi: 6 erano sintomatici, 3 asintomatici. Sono stati studiati con TC del torace e dell