Bronchography

Bronchography is X-ray examination of the tracheobronchial tree after instillation of a radiopaque iodine contrast agent through a catheter into the lumens of the trachea and bronchi. The contrast agent coats the bronchial tree, permitting visualization of any anatomic deviations. Bronchography of a localized lung area may be accomplished by instilling contrast dye through a fiber-optic bronchoscope placed in the area to be filmed.

Since the development of computed tomography scanning, bronchography is used less frequently. It may be performed using a local anesthetic instilled through the catheter or bronchoscope, although a general anesthetic may be necessary for children or during a concurrent bronchoscopy.

Purpose

• To help detect bronchiectasis, bronchial obstruction, pulmonary tumors, cysts, and cavities and, indirectly, to pinpoint the cause of hemoptysis
• To provide permanent films of pathologic findings

Patient Preparation

• Explain to the patient that this test helps evaluate abnormalities of the bronchial structures.
• Instruct the patient to fast for 12 hours before the test.
• Tell him to perform good oral hygiene the night before and the morning of the test.
• Explain who will perform the test, where it will take place, and its expected duration.
• Make sure the patient or a responsible family member has signed a consent form.
• Check the patient's history for hypersensitivity to anesthetics, iodine, or contrast media.
• If the patient has a productive cough,administer a prescribed expectorant and perfonn postural drainage I to 3 days before the test.
• If the procedure is to be performed under a local anesthetic, tell the patient he'll receive a sedative to help him relax and to suppress the gag reflex. Prepare him for the unpleasant taste of the anesthetic spray. Warn him that he may experience some difficulty breathing during the procedure, but reassure him that his airway won't be blocked and that he'll receive enough oxygen. Tell him the catheter or bronchoscope will pass more easily if he relaxes.
• If bronchography is to be perfonned under a general anesthetic, inform the patient that he'll receive a sedative before the test to help him relax.
• Just before the test, instruct the patient to remove his dentures and to void.

Tilting table, sedative, anesthetic, catheter or bronchoscope, radiopaque oils or water-soluble contrast agent, emergency resuscitation equipment

Procedure And Posttest Care

• After a local anesthetic is sprayed into the patient's mouth and throat, a bronchoscope or catheter is passed into the trachea, and the anesthetic and contrast medium are instilled.
• The patient is placed in various positions during the test to promote movement of the contrast medium into different areas of the bronchial tree. After X-rays are taken, the contrast medium is removed through postural drainage and by having the patient cough it up.

  CLINICAL ALERT: Watch for signs of laryngeal spasms (dyspnea) or edema (hoarseness, dyspnea, laryngeal stridor) secondary to traumatic intubation.

  CLINICAL ALERT: Immediately report signs of allergic reaction to the contrast medium or anesthetic, such as itching, dyspnea, tachycardia, palpitations, excitation, hypotension, hypertension, or euphoria.

• Withhold food, fluids, and oral medications until the gag reflex returns (usually in 2 hours). Fluid intake before the gag reflex returns may cause aspiration.
• Encourage gentle coughing and postural drainage to facilitate clearing of the contrast medium. A postdrainage film is usually done in 24 to 48 hours.
• Watch for signs of chemical or secondary bacterial pneumonia- fever, dyspnea, crackles, or rhonchi - the result of incomplete expectoration of the contrast medium.
• If the patient has a sore throat, reassure him that it's only temporary, and provide throat lozenges or a liquid gargle when his gag reflex returns.
• Advise the outpatient not to resume his usual activities until the next day.

Precautions

• Bronchography is contraindicated during pregnancy, in persons with hypersensitivity to iodine or contrast media, and usually in persons with respiratory insufficiency.
• Observe the patient with asthma for laryngeal spasm secondary to the instillation of the contrast medium.
• Observe the patient with chronic obstructive pulmonary disease for airway occlusion secondary to the instillation of the contrast medium.

Normal Findings

The right mainstem bronchus is shorter, wider, and more vertical than the left bronchus. Successive branches of the bronchi become smaller in diameter and are free of obstruction or lesions.

Abnormal Findings

Bronchography may demonstrate bronchiectasis or bronchial obstruction due to tumors, cysts, cavities, or foreign objects. Findings must be correlated with physical examination, patient history, and perhaps other pulmonary studies.

Interfering Factors

• Presence of secretions, inability to suppress coughing, or improper patient positioning (possible poor imaging due to inadequate filling of bronchial tree)