Bronchography in pulmonary tuberculosis.

For 30 years after the introduction of broncho-graphy by Sicard and Forestier (1922) iodized oil remained the only contrast medium in general use. During this period a large amount of information was published about the radiographic appearance of the bronchi in most varieties of chronic pulmonary disease. The literature dealing with bronchography in pulmonary tuberculosis is scanty by comparison. Early hopes that iodized oil might help to demonstrate tuberculous cavities met with disappointment, because the bronchi draining them are usually too narrow and tortuous to admit the contrast medium (Landau, 1925). Dilatation of the bronchi leading to tuberculous lesions was noted by Grill (1927), who also described stenosis of one of the main bronchi in one of his cases. The appearance of the bronchi in pulmonary tuberculosis was discussed in more detail by Leuret, Secousse, and Caussimon (1927), in an account based on 55 cases. They demonstrated fusiform and saccular dilatation of the bronchi, stenosis, and obstruction; but, like others, they were rarely successful in outlining cavities. For some years after these early reports interest in bronchography of tuberculous patients was temporarily lost until the wider application of surgical treatment brought with it the need for more precise information about the topography of the infection. The practical value of broncho-graphy in the localization of cavities was stressed for the first time by Neuhof (1934), while Potter and Pagliughi (1936) and Cabitt, Singer, and Graham (1936) found that the calibre of the bronchi under a thoracoplasty gave some indication of the success of the operation. The largest series of tuberculous patients studied by broncho-graphy was reported in a series of papers by Dormer, Friedlander, and Wiles (1944, 1945), who laid emphasis on the more striking bronchial changes, especially dilatation, encountered amongst over 2,000 bronchograms. An attempt to estimate the incidence of bronchiectasis in tubercu!ous lesions was made by Murphy (1934), who noted it in 60 % of his bronchograms, and by Boyer (1946), who studied a series of 50 unselected cases and found dilatation in 85%. The somewhat lower figure of 51.8% is given by Buckles, Potts, Davidson, and Neptune (1951) in their report on the bronchograms of 222 consecutive tuberculous patients. As long as iodized oil remained the only contrast medium available for bronchography, the general reluctance to carry out this investigation on tuberculous patients was well founded. It was widely believed that a local tissue reaction to residues of …