PEDIATRICS Vol. 30 No. 3 September 1962, pp. 378-388
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BRONCHOGRAPHY IN INFANTS AND CHILDREN

I. A Non-fluoroscopic Technique

William W. Waring M.D.1 and Donald E. Killelea M.D.1

1 Department of Pediatrics, Tulane Medical School, and the Charity Hospital of Louisiana, New Orleans

Bronchography in infants and young children requires a procedure different from that generally employed in adults. A safe and reliable technique has been reviewed which eliminates the need for fluoroscopic control of the madiopaque medium.

Under general anesthesia the contrast material is fractionally instilled through an endotracheal tube and guided sequentially by gravity to all segmental bronchi of the lung. The patient's color and respiration can be observed continuously throughout the procedure.

Conventional roentgenograms are taken, and the medium is then removed by gravity and suction. If desired, the contralateral lung may next be visualized by analogous maneuvers. Bronchography by this method requires a team of two operators, anesthesiologist, radiology technician, and probably a surgeon. The team can be effectively integrated by a pediatrician interested in chest disease who serves as one of the operators.

Fifty-eight bronchograms have been performed by this method in 52 children between the ages of 2 months and 13 years.

Criteria are outlined for determination of the adequacy of bronchograms. These criteria have been applied to this series on a segmental basis with totals tabulated for lobes and lungs. Bronchograms of adequate or better diagnostic quality were obtained in approximately 85% of the 53 bronchograms available for review. Failure to visualize a segment may be due to disease of that segment or to several technical factors. These latter include either extreme of anesthetic depth, failure to position the patient properly, excessively caudal placement of the endotracheal tube, delivery of medium into the endotracheal tube rather than just distal to it, and procedural delays due to any cause.

No deaths ascribable to the method have occurred. Complications in this series, however, have included cardiac arrest (one patient); bradycardia (one patient); and acute, transitory lobar atelectasis (three patients). These complications seem best related to airway obstruction by viscous contrast material.