A SIMPLE METHOD OF BRONCHO-

GRAPHY J k

By S. P-(BASU ?

Department of Radiology, School oj Tropical Medicine, Calcutta

Iodum has an atomic weight of 126.92 and is radio-opaque. It and its suitable salts, when introduced into cavities or circulation, cast a shadow for proper evaluation of pathological condition.

The concentration of iodine in iodized poppy- seed oil is 40 per cent. The colour of the solution is amber. When the colour changes to grey the solution is to be discarded, as there is liberation of free iodine which will induce bronchitis.

There are three different ways of introducing or injecting iodized oil into the bronchi. The original method is the direct injection into the trachea through the cricothyroid membrane and is still being used by a good majority. The

others are transglottic and nasal catheter methods. These two are almost one and the same excepting that in the latter the nose is selected as the channel for introducing the catheter. Direct injection is always preferable for children and neurotic subjects. The method used in the X-ray Department,

School of Tropical Medicine, Calcutta, is an improvement on the transglottic method, and is as follows :?

The patient is given a dose of mist. pot. iodide (gr. 10 to 1 oz.) the night before at bed- time to test his iodism. If the report is favourable, he is prepared for bronchography in the afternoon having finished his lunch 3 to 4 hours before..

The following are required :? 1. 20 cc. iodized oil (40 per cent iodine in

poppy-seed' oil)?say neo-hydriol [May & Baker (India), Ltd.].

2. All-glass 20 cc. syringe without needle. 3. 4 per cent solution of cocaine 15 cc.

4. Dressing?swabsticks and a few pieces of cotton-wool.

1st step

The patient sits in a chair facing good light? the tongue is pulled with a piece of gauze and throat swabbed with cocaine solution. Two or three applications are made at an interval of five minutes, until the cough reflex is gone.

2nd step

Two cc. of the cocaine solution are then injected through one of the nostrils thus : when the tongue is being pulled by the left hand and the patient asked to take long deep breaths, the right hand injects the solution. So long the tongue is pulled, the patient cannot swallow and the solution goes into the trachea. A sudden bout of cough indicates that the solution has entered the trachea. The patient is asked to lie on his side on a bench.

3rd step

In five minutes' time, when the anaesthesia is well established in the bronchial tree, iodized oil is injected through the anaesthetized nostril and the tongue pulled as before. The patient sits with inclination to the right for the 1st 5 cc.r and to the left for 2nd 5 cc., and lies on the right side for the 3rd 5 cc. and on the left side for the last 5 cc. For the last two injections the chest lies at a lower level than the hips. Skiagrams are taken immediately. As patients always complain of a violent spasm of cough, all necessary preparations are to be made so that the skiagram can be taken in the shortest possible time. He is prohibited from taking any food or drink for 2 to 3 hours afterwards to avoid ' drowning

200 THE INDIAN MEDICAL GAZETTE [May, 1951

The advantage of this method is that it avoids the use of a needle, special appliances and services of a specialist. About 5.0 cases have been done in this depart-

ment and we have not recorded any failure.

Nowadays bronchography and bronchoscopy are being done almost as a routine measure in all chest conditions as we do a skiagram of chest. Bronchoscopy needs a special instrument and a specialist, whereas bronchography, as mentioned above, can easily be done by a radiologist even in a mofussil town. Bronchography, as a method of investigation for various lung condi- tions, has proved its worth beyond doubt.

Reproductions from skiagrams taken under the auspices of the Tuberculosis Relief Association are shown in plate XIII.

Plate XIII

A SIMPLE METHOD OF BRONCHOGRAPHY : S. P. BASF. (0. A.) PAGE 199

Broncliogram for saccular broachiectasis, Riajhfc lateral view.

Broachogram for saccular bronchiectasis, Riaht lateral view.

Bronchogram for saccular bronchiectasis Postero-anterior view.

Bronchogram for saccular bronchiectasis Postero-auterior view.