A technique of bronchography with visciodol: a new contrast medium.

Since the first bronchography was performed by Chevalier Jackson’ in 1918 with the use of bismuth powder insufflated through a bronchoscope, there has been a constant search for more satisfactory bronchographic contrast media. The procedure did not gain widespread acceptance until the epoch making discovery by Sicard and Forestier2 in 1923, that Lipiodol made a satisfactory contrast medium for this examination. Other iodized oils were subsequently introduced, but none was able to surmount the following common objections to their use for this procedure: 1) Retention within the alveoli obscures any accurate follow-up for long periods of time, as elimination from the lung is slow. 2) The retained iodine interferes with any subsequent radiation therapy.8 3) Delay in any contemplated pulmonary surgery due to an increased incidence of post-operative atelectasis in cases having had recent bronchography with alveolar penetration.4 4) Alveolograms are far more difficult to interpret than bronchograms. 5) Reported formation of iodized oil granulomas.5 6) Prolongation of reactions in iodine sensitive individuals due to slow liberation of iodine. 7) Repeat bronchograms impossible for long periods of time due to obscuring shadows of alveolar oil. These objections led to the introduction of water-soluble contrast agents. loduron B and Umbradil Viscous B were introduced in 1948. More recently Dionosil Aqueous in a carboxymethylcellulose base has become available. These agents are not without their own particular group of inherent objectionable qualities. We feel, as do other workers,#{176} that these objectionable qualities makes their use as undesirable as the use of the unaltered iodized oils for this procedure. The chief objections to the use of these water-soluble agents are: 1) They produce severe local irritation and require deep topical anesthesia.6’ 7 2) The radiographic images produced by these agents are less dense than those produced by the iodized oils due to lower iodine content. This is particularly important on the lateral projection.8 3) Undue haste must be employed during the procedure due to their rapid absorption. 4) The carboxymethylcellulose present as the base of these agents has