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
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
Wolfe, James D.; Simmons, Daniel H.
Hemoptysis is one of the most important symptoms of cardiopulmonary disease—first, because bleeding even in small amounts may indicate the presence of such serious diseases as bronchogenic carcinoma or active tuberculosis, and second, because untreated massive hemorrhage is associated with a high mortality rate. The cause of hemoptysis may be suggested by the history, physical examination or chest x-ray findings, but often diagnostic procedures such as bronchoscopy, bronchography and pulmonary angiography are needed for definitive diagnosis. The importance of early localization of the bleeding site and surgical intervention in patients with massive hemoptysis is stressed. PMID:919539
Leduc, D; Gris, P; Lheureux, P; Gevenois, P A; De Vuyst, P; Yernault, J C
A lifelong non-smoker who was the victim of a massive accidental exposure to anhydrous ammonia gas was followed up for 10 years. In the acute phase the patient presented with severe tracheobronchitis and respiratory failure, caused by very severe burns of the respiratory mucosa. After some improvement he was left with severe and fixed airways obstruction. Isotope studies of mucociliary clearance, computed tomography, and bronchography showed mild bronchiectasis. It is concluded that acute exposure to high concentrations of ammonia may lead to acute respiratory injury but also to long term impairment of respiratory function. Images PMID:1440475
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
Kaschula, R O; Druker, J; Kipps, A
Pneumonia that occurs within 28 days of the onset of measles rash is a common cause of severe pulmonary morbidity and/or death among poor children. The prevalence of such pneumonia can be related to the effectiveness of measles immunization programs. For 20 of 57 new cases of bronchiectasis in children undergoing bronchography, a strong causal relationship to measles was found. The lungs of 21 unselected children who died in the wake of measles were examined. Severe necrosis of bronchi and bronchioles was found in those children who had developed intercurrent adenovirus and herpesvirus infections. Bacterial suppuration produced a less severe necrosis. It is suggested that intercurrent adenovirus and herpesvirus infections that occur following measles are the most important initiating causes of follicular bronchiectasis in childhood. The severity of these supervening infections may be mediated by the transient immune suppression that occurs as a consequence of both measles and inadequate nutrition. PMID:6308746
Herbert, F. A.; Wilkinson, D.; Burchak, E.; Morgante, O.
An outbreak of adenovirus type 3 infection occurred in a hospital in 19 North American Indian infants and young children who were being treated for unrelated problems. Pneumonia occurred in 14 and was usually severe, with persistent signs of airway obstruction. Eleven of the 14 were followed periodically and complete medical reviews were conducted 8 to 10 years later. Ten had abnormal chest radiographs, and bronchography revealed bronchiectasis and minor airways changes in seven. In three cases there was clear evidence that these changes were directly related to the adenovirus type 3 infection. Pulmonary function studies showed a combination of restrictive and obstructive changes with minimal hypoxemia in most. Despite the presence of a persistent productive cough all were able to carry on a relatively normal life. Images FIG. 1 FIG. 2 FIG. 3 PMID:189889
Over the past two decades there has been a phenomenal growth in the number of dedicated synchrotron radiation facilities and a corresponding growth in the number of applications in both basic and applied sciences. The high flux and brightness, tunable beams, time structure and polarization of synchrotron radiation provide an ideal x- ray source for many applications in the medical sciences. There is a dual aspect to the field of medical applications of synchrotron radiation. First there are the important in-vitro programs such as structural biology, x-ray microscopy, and radiation cell biology. Second there are the programs that are ultimately targeted at in-vivo applications. The present status of synchrotron coronary angiography, bronchography, multiple energy computed tomography, mammography and radiation therapy programs at laboratories around the world is reviewed.
Martínez-Martínez, Blanca Estela; Furuya, María Elena Yuriko; Martínez-Muñiz, Irma; Vargas, Mario H; Flores-Salgado, Rosalinda
A seven-month-old girl, born prematurely (birth weight 1000 g) from a twin pregnancy, was admitted to hospital due to recurrent pneumonia and atelectasis. She experienced cough and respiratory distress during feeding. The right hemithorax was smaller than the left, with diminished breath sounds and dullness. Chest x-rays revealed decreased lung volume and multiple radiolucent images in the right lung, as well as overdistention of the left lung. An esophagogram revealed three bronchial branches arising from the lower one-third of the esophagus, corresponding to the right lung and ending in a cul-de-sac. A diagnosis of esophageal lung was established. On bronchography, the right lung was absent and the trachea only continued into the left main bronchus. Echocardiography and angiotomography revealed agenesis of the pulmonary artery right branch. The surgical finding was an esophageal right lung, which was removed; the histopathological diagnosis was type II congenital pulmonary airway malformation in an esophageal lung. PMID:23762890
Chan, C. H.; Ho, A. K.; Chan, R. C.; Cheung, H.; Cheng, A. F.
In 91 patients with bronchiectasis seen over 6 years, a positive mycobacterial culture was obtained in 12 cases (13%). The organisms isolated were Mycobacterium tuberculosis in nine cases, Mycobacterium avium in two cases and Mycobacterium tuberculosis and chelonei were obtained on separate occasions in one case. Computed tomography and/or bronchography showed that the bronchiectatic changes commonly involved the lower lobes and to a lesser extent, the middle and lingula lobes. In none of these 12 cases was tuberculosis strongly suspected on clinical or radiological grounds. We conclude that mycobacterial infections are common in patients with bronchiectasis and sputum should be cultured for mycobacteria periodically in these patients. In doubtful cases, bronchoscopy may be helpful to obtain a positive mycobacterial culture. PMID:1494510
Nishimura, K; Kitaichi, M; Izumi, T; Kanaoka, M; Itoh, H
Though bronchiolitis obliterans organizing pneumonia (BOOP) was proposed as a new infiltrative lung disease in 1985, we think it has two radiologic problems. First, in spite of interstitial pneumonia, about half of chest radiographs of BOOP has been reported to show alveolar opacities. Second, because radiologic features of both some cases of BOOP and of usual interstitial pneumonia (UIP) show reticular shadows on chest radiographs, it is sometimes difficult to differentiate between two diseases. We correlated CT images with open lung biopsy specimens and evaluated CT's ability to differentiate BOOP from UIP. CT findings of all cases of BOOP were: (1) markedly increased dense infiltrates of various sizes which demarcated sharply from normal lung field. Air bronchogram was always present. (2) less dense images were seen which also stood out against the normal lung field. The former corresponded to air space consolidation formed by organized exudates and inflammatory cells within alveolar ducts and alveoli, while the latter indicated luminal and mural alveolitis. Both findings were sharply delineated from each other probably because of intervening interlobular septa. Conglomerated small cystic shadows and air bronchography within areas of intense lung density were seen in CT images of most of 28 patients with UIP. Those findings proved to correspond to macroscopic or microscopic honey combing which were not seen in our cases of BOOP. These radiologic and pathologic features of UIP were different. PMID:2724593
Baker, R R
A number of new concepts in the clinical management of bronchogenic carcinoma have been introduced since an original review of this problem in The Johns Hopkins Medical Journal in 1967. Four specific problems in the updated management of patients with bronchogenic carcinoma are discussed: 1) the patient with cytologic evidence of malignant cells in the sputum and a normal chest radiograph; 2) the patient with an asymptomatic peripheral pulmonary nodule; 3) the patient with symptomatic bronchogenic carcinoma or bronchogenic carcinoma in a lobar or main stem bronchus; 4) the assessment of operability. Tantalum bronchography and fiberoptic bronchoscopy have proven effective in localizing the source of malignant cells shed from a radiologically occult bronchogenic carcinoma. Percutaneous needle biopsy and transbronchial biopsy under fluoroscopic control permit pathological examination of peripheral nodules. Transcervical mediastinoscopy and left parasternal exploration, as well as increased use of angiography and more sophisticated pulmonary function tests, allow better determination of the resectability of central lesions. As a result, fewer patients are subjected to unnecessary thoracotomies, and if thoracotomy is undertaken it usually offers the patient a reasonable chance of cure. PMID:1185914
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.
Zhang, H.; Zhu, Y.; Bewer, B.; Zhang, L.; Korbas, M.; Pickering, I. J.; George, G. N.; Gupta, M.; Chapman, D.
K-Edge Subtraction (KES) utilizes the discontinuity in the X-ray absorption across the absorption edge of the selected contrast element and creates an image of the projected density of the contrast element from two images acquired just above and below the K-edge of the contrast element. KES has proved to be powerful in coronary angiography, micro-angiography, bronchography, and lymphatic imaging. X-ray fluorescence imaging is a successful technique for the detection of dilute quantities of elements in specimens. However, its application at high X-ray energies (e.g. at the iodine K-edge) is complicated by significant Compton background, which may enter the energy window set for the contrast material's fluorescent X-rays. Inspired by KES, Fluorescence Subtraction Imaging (FSI) is a technique for high-energy (>20 keV) fluorescence imaging using two different incident beam energies just above and below the absorption edge of a contrast element (e.g. iodine). The below-edge image can be assumed as a "background" image, which includes Compton scatter and fluorescence from other elements. The above-edge image will contain nearly identical spectral content as the below-edge image but will contain the additional fluorescence of the contrast element. This imaging method is especially promising with thick objects with dilute contrast materials, significant Compton background, and/or competing fluorescence lines from other materials. A quality factor is developed to facilitate the comparison. The theoretical value of the quality factor sets the upper limit that an imaging method can achieve when the noise is Poisson limited. The measured value of this factor makes two or more imaging methods comparable. Using the Hard X-ray Micro-Analysis (HXMA) beamline at the Canadian Light Source (CLS), the techniques of FSI and KES were critically compared, with reference to radiation dose, image acquisition time, resolution, signal-to-noise ratios, and quality factor.
In the relatively short time that synchrotrons have been available to the scientific community, their characteristic beams of UV and X-ray radiation have been applied to virtually all areas of medical science which use ionizing radiation. The ability to tune intense monochromatic beams over wide energy ranges clearly differentiates these sources from standard clinical and research tools. The tunable spectrum, high intrinsic collimation of the beams, polarization and intensity of the beams make possible in-vitro and in-vivo research and therapeutic programs not otherwise possible. From the beginning of research operation at the National Synchrotron Light Source (NSLS), many programs have been carrying out basic biomedical research. At first, the research was limited to in-vitro programs such as the x-ray microscope, circular dichroism, XAFS, protein crystallography, micro-tomography and fluorescence analysis. Later, as the coronary angiography program made plans to move its experimental phase from SSRL to the NSLS, it became clear that other in-vivo projects could also be carried out at the synchrotron. The development of SMERF (Synchrotron Medical Research Facility) on beamline X17 became the home not only for angiography but also for the MECT (Multiple Energy Computed Tomography) project for cerebral and vascular imaging. The high energy spectrum on X17 is necessary for the MRT (Microplanar Radiation Therapy) experiments. Experience with these programs and the existence of the Medical Programs Group at the NSLS led to the development of a program in synchrotron based mammography. A recent adaptation of the angiography hardware has made it possible to image human lungs (bronchography). Fig. 1 schematically depicts the broad range of active programs at the NSLS.
Endobronchial localizations of benign neoplasms are met with in 24.5 per cent of the cases. Right lung localizations are more frequent. More than half of them are broadly based (57.5 per cent). In most of the cases it is a matter of nonepithelial tumours of which a greater intensity is displayed by hamartomas /7/, vascular /4/ and neurogenic /3/ neoformations. The size of endobronchial tumours varies from 1 to 10 cm. Cases measuring 1-3 cm are the most numerous. Those of the "iceberg" type appear to be larger. The size per se has a relative importance for the clinical picture. Endobronchial tumours exhibit a clear cut clinical picture, and run a clinical course in three stages, determined by the degree of bronchial obturation and longstanding of the condition. The most common symptoms are coughing /80.7 per cent/, expectoration /50.0 per cent/, rales /57.6 per cent/, dullness /38.4 per cent/ and lacking respiration /38.4 per cent/. The nosological entity by itself is less conclusive for the clinical course. The X-ray data have orientation and by no means decisive significance for the diagnosis. The "crab pincers" sign in the bronchial lumen during bronchography has a definite importance. Bronchoscopy in conjunction with biopsy is a dependable method of preoperative diagnosing. It contributes greatly to the nosological diagnosis. Even nowadays, the diagnosis of endobronchial tumours is difficult. A rather exact diagnosis can be made intraoperatively, whereas the most accurate diagnosis is established only after histological study. The treatment of endobronchial benign neoplasms is operative. The number of medium /lobectomies/ and extensive /pulmonectomies/ pulmonary resections is considerable. In case of early diagnosis and intervention, sparing resection is the naturally indicated size of operation - mainly resection and plasty of the bronchi without lobectomy. The advantages of circular resection are substantial. Reconstructive operations of "clarinet" and