Bronchoscopy and bronchography in emphysema and chronic bronchitis. Demonstration of morphologic changes in an attempt at appraisal of severity of functional impairment.

S TIMES AND INVESTIGATIVE METHODS change and contrast media are improved , one is tempted to assemble the various findings and correlate them with the known pathologic alterations in chronic bronchitis and pulmonary emphysema. The following text and illustrations deal with certain aspects of morphologic findings as seen by the clinician in the course of a pulmonary study. This study is based upon routine bronchoscopic and bronchographic examinations performed in a general hos-*Fron5 the Medical and Surgical Departments and the Pulmonary Laboratory, Church Home and Hospital. pital of pulmonary orientation, and from a thorough workup of advanced pulmonary emphysema cases preliminary to a surgical , space-reducing, therapy approach.' It afforded the present authors some unusually bizarre findings which, in the light of newer concepts of bronchitis in relation to pulmonary emphysema, may help the clin-ician to a better understanding of the mechanism of these disease entities. Most of the bronchoscopic findings of mucosal thickening, edema, hyperemia, ul-ceration, the presence of various exudates, and deformity by scarring are well known to every endoscopist. Thee e manifestations of chronic bronchitis, with or without acute exacerbations, are easily visualized on direct view. Other findings, such as dilated FIGURE 1: Drawing of telescopic appearance of openings of dilated bronchial glands. A portion of the left upper lobe orifice and the postero-lateral wall of the left main bronchus are shown, with numerous areas of pitting. Bronchographic demonstration of irregularly dilated bronchial glands in the floor of the left upper lobe bronchus; advanced emphysema case.