Comparison of bronchograms after instillation of contrast medium via fibreoptic bronchoscope and nasal catheter.

Bronchography using a fibreoptic bronchoscope to instill the contrast medium is increasingly popular, with an estimated 526 procedures performed in the United Kingdom in 1983.1 2 The qualities of bronchograms obtained by this and by conventional techniques have not been compared. We organised a retrospective study to compare the results of bronchography via a fibreoptic bronchoscope with those obtained via a nasal catheter. Methods Bronchograms from 40 consecutive caucasian patients, who underwent bilateral bronchography from November 1984 to March 1986 to establish the presence and extent of bronchiectasis, were assessed retrospectively by an independent pulmonary radiologist. He completed a standard form designed to determine the quality of each bronchogram. Twenty patients had bronchography performed via a fibreoptic bronchoscope and, by coincidence, 20 had bronchography via a nasal catheter. Segments of the bronchial tree inadequately filled by contrast medium, segments with bronchiectasis, and lobes with a considerable excess of mucus were noted. The degree of inspiration achieved, the technical quality of the radiographs, the comprehensiveness of the series of films, any problems of interpretation caused by the presence of the fibreoptic bronchoscope or nasal catheter, and a visual analogue score (0-100 mm) of the overall quality of each bronchogram were also recorded. The fibreoptic bronchoscope or nasal catheter was visible on each set of films. Bronchography was performed in a similar manner in the two groups except for the use of either fibreoptic bronchoscope or nasal catheter. Patients were given atropine 06 mg and usually papaveretum one hour before the procedure. Physiotherapy was prescribed if indicated. Each procedure was performed by an experienced pulmonary radiologist (10 by one consultant radiologist) or by a radiologist under experienced supervision (13 by one senior registrar), with the assistance of a radiographer and in the case of the group examined by fibreoptic bronchocope also a physician. Both fibreoptic bronchoscope and nasal catheter were passed nasally under local anaesthesia (lignocaine). In the group examined by fibreoptic bronchocope visual inspection of the bronchial tree and aspiration of secretions were routine. Before instillation of the contrast medium (aqueous propyliodone-Dionesil, Glaxo) the fibreoptic bronchocope or nasal catheter was positioned in the main bronchus with the right side always examined first. If incomplete filling obviously occurred during the procedure, the fibreoptic bronchocope or nasal catheter was repositioned to allow more local filling. A series of radiographs was taken while the patient was asked to refrain from coughing. The patient was …