Bronchography amination of bronchial tree after introducing of radio-opaque It is a radiologic ex: e catheter or contrast media. The contrast media introduced through th bronchoscope. The bronchography may be performed to diagnose the structure and functional abnormalities of larynx trachea and bronchi During the bronchography, a catheter or a bronchoscope inserted through the nose and advanced down into the trachea and bronchi then the contrast media is injected, The Contrast media gives the better visualization of the anatomy and abnormalities in the trachea and bronchi by forming a coating on the interior wall of these structures. Now a day’s bronchography has been obsolete. It is replaced by CT scan (HRCT) and flexible Bronchoscopy. Anatomy - ¢ The Lungs-Lungs are a pair of organs pyramid-shaped located in the chest cavity. Both Lungs rests on the diaphragm. Fach lung is enclosed by the pleura. The blood vessels and airways pass into the lungs through hilum Each lung is composed of lobes. The right lung consists of three lobes- the superior, middle, and the inferior and the left lung consists of two lobes- the superior and the inferior .the fissures separate these lobes from each other.: lood and The main functions of the lungs are to exchange oxygen into the b to release carbon dioxide ea, bronchi, The air enters the mouth or nose and passes through the trachea, b and bronchioles to the tiny aur sacs called alveoli © The larynx- Ii is also called the voice box it produces sound and protects the trachea against food aspiration, © The trachea- [t connects the larynx .trachea divided into left and night bronchi. The bronchi divide into smaller branches called bronchioles Bronchioles divide into very smaller branches called terminal bronchioles Terminal bronchioles Connected with tiny alveoliwhere the gaseous exchange takes place Indication- * Bronchiectasis (Permanent dilation of bronchi and bronchioles ) * Bronchitis (The wall of bronchi and bronchioles become thickened) © Hemoptysis (coughing blood) ¢ Tracheoesophageal fistula (tract between trachea and esophagus) ¢ Pulmonary lesion and mass ¢ Chronic obstructive pulmonary disease Contraindication- . Hypersensitivity to iodine © Suspected pregnancy © Diabetic * Severe hypertension . Cardiopulmonary disease * AsthmaEquipment- © Fluoroscopy unit with spot fi Topical anesthesia Xylocaine Jelly and spray Contrast media Dionosil 20 ml for unilateral and 40 mt for bilateral Lung examination - Dionosil is an oil based Low viscosity iodinated contrast media which gives better Visualization. Now a day’s nonionic monomer (iohexol) Im device/ Image receptor/Cassette contrast media use for bronchography e Catheter or bronchoscope e Syringe e Gauze e Antiseptic solution and mouthwash e Suction machine Patient preparation- Fasting may be employed for 4 hours. Asked the patient not to eat or drink after midnight. Pre-procedure investigations must be reviewed by the radiologist e@ Chest x-ray report ¢ Blood Urea e Serum creatinine ¢ Blood sugar report ¢ History of Previous medication, bleeding disorder, taken by the radiologist Procedure- 1. On the day of examination describe the whole procedure to the patient. 2. Technologist should obtain consent from the patient for permission of procedure. 3. Ask the patient to remove clothing and wear a Hospital gown. Place the patient in the supine position with an empty bladder on the X-ray fluoroscopic table.e An intravenous ae © 1s inserted into the patient arm and sedative medication is given through the line to make the patient relax. 5 6. Blood Pressure, heart rate, Respiration rate, oxygen leyel, and other vital sign should be monitored during the procedure. The aerosol spray anesthesia 4s given in the patient mouth for numbing and to prevent gagging during the procedure. The patient head is placed in hyperextension position then the Radiologist introduces a catheter through the nose down into trachea under the fluoroscopy guidance. 7. At the level of Carina additional anesthesia is given in each side. 8. Then the patient is placed in rey Trendelenburg position (head up and feet down) 9. This reverse position, allows the contrast media flow into the bronchus by the gravity 10. An average of 20 ml contrast media injected in each bronchus through the catheter Right side bronchography examination- Lift the left side at 20 to 30 degree, so the contrast media flows in the upper, middle and lower lobes of the lung, with the help of gravity. Approximately 5 mi contrast media required for each lobe Left side bronchography examination- Lift the right side at 20 to 30 degree so the contrast media floor in the upper and lower lobe of the lung, with the help of gravity. The patient must be instructed for Shallow breathing and avoid coughing during the procedure, during injection of the contrast media under fluoroscopy guidance Use Suction machine for suction of saliva during the procedure. Several radiographs are taken through a spot film device in various positions like PA, right and left lateral, right anterior oblique and left anterior oblique, to evaluate the abnormalities in the lung. After completion of the examination, the catheter or the bronchoscope will be removed and the patient is shifted in the observation roomtiographic Inv Q Aftereare- © Keep the patient under observation blood pressure, heart rate, oxygen level, Fluid balance, and other vital sign must be monitored. Instruct the Patient for coughing, to split the remaining contrast media from Airways. e Afier the 24 hours of the procedure, the x-ray of the chest PA performs to assess the remaining contrast media in airways. 1 Complication- © Pneumonia e Pulmonary edema e Inflammation and infection in lungs e Difficulty in breathing. pre Fig: Right Bronchogram