Bronchogram

Bronchography is a radiographic (x-ray) examination of the lower respiratory tract's internal passages. The lower respiratory tract features, which include the larynx (voice box), trachea (windpipe), and bronchi (larger branching airways to the lungs), become apparent on x-ray film after contrast dye is injected into these areas through a catheter or bronchoscope (thin, flexible, lighted tube). Contrast dye is a chemical that increases the visibility of a specific organ, tissue, or structure on x-ray or other diagnostic pictures.

Reasons for the Procedure

A bronchography may be performed to diagnose structural or functional abnormalities of the larynx, trachea, and/or bronchi. Abnormalities may include, but are not limited to, the following:

• Bronchiectasis - An irreversible enlargement of the bronchi as a result of deterioration of the muscle and elastic tissue of the bronchial walls. Generally, this is the result of chronic inflammation from various causes.
• Hemoptysis - Coughing up blood
• Tracheoesophageal fistula - Abnormal tract between trachea (windpipe) and esophagus (hollow tube used for swallowing)
• Tumors (abnormal growths)
• Chronic pneumonia or bronchitis

There may be other reasons for your physician to recommend a bronchography.

Risks of the Procedure

As with any invasive procedure, complications may occur. Complications related to bronchography may include, but are not limited to, the following:

• Infection or pneumonia.
• Airway obstruction from the contrast dye in patients with emphysema or chronic bronchitis.
• Bronchospasm or laryngospasm from the contrast dye in patients with asthma.

You should consult your doctor about the amount of radiation utilized during the operation as well as the hazards associated with your specific scenario. Keep a note of your previous history of radiation exposure, such as previous scans and other types of x-rays, so you can alert your doctor. The cumulative number of x-ray examinations and/or treatments over a lengthy period of time may be related to the risks associated with radiation exposure.

Before the Procedure

• Your doctor will explain the procedure to you and give you the opportunity to ask any questions you may have about it.
• You will be asked to sign a consent form granting authorization to do the surgery. If something is unclear, read the form carefully and ask questions.
• If you are allergic or sensitive to drugs, local or general anesthesia, contrast dyes, iodine, or latex, notify your doctor.
• Before the procedure, you will be requested to fast for a particular amount of time. Your doctor will advise you on how long you should fast, whether for a few hours or overnight.
• You should contact your doctor if you are pregnant or suspect you are pregnant.
• Inform your doctor about all medications (prescription and over-the-counter) and herbal supplements you are using.
• If you have a history of bleeding issues or are on anticoagulant (blood-thinning) drugs, aspirin, or other medications that alter blood clotting, please notify your doctor. You may need to stop using these medications before the surgery.
• Prior to the operation, you may be requested to undertake complete oral hygiene.
• If a sedative is administered prior to the surgery, you may require someone to take you home afterwards. If the surgery requires general anesthesia, you will be given a sedative before the procedure.
• Your doctor may request further preparation based on your medical condition.

During the Procedure

A bronchography can be done as an outpatient procedure or as part of a hospital stay. Procedures may differ depending on your situation and the practices of your doctor.

Generally, a bronchography follows this process:

• You'll be asked to take off any clothing, jewelry, dentures, or other anything that might get in the way of the process.
• You will be provided a gown to wear if you are requested to remove your garments.
• Prior to the treatment, you will be asked to empty your bladder.
• An IV line may be placed into your arm or hand.
• During the process, your heart rate, blood pressure, breathing rate, and oxygen level may be checked.
• You will be seated upright on a table that can tilt you from horizontal to upright as well as other positions. Changing positions helps the contrast dye distribute into different areas for examination.
• A sedative may be used to make you sleepy but arousable.
• To minimize gagging as the bronchoscope is passed down your throat into your stomach, numbing medication will be sprayed into the back of your throat. The spray could have a bitter flavor. Holding your breath while the doctor sprays your throat may help to reduce the taste.
• Because of the bronchoscope in your throat, you will be unable to swallow any saliva that may accumulate in your mouth throughout the surgery. Your saliva will be suctioned out of your mouth on occasion.
• The catheter or bronchoscope will be moved down the back of the throat into the trachea and bronchus, infusing contrast dye as it goes.
• When the catheter or bronchoscope is advanced, you may feel some discomfort. Your airway will not get obstructed.
• Your doctor will take x-rays in various positions.
• The catheter or bronchoscope will be removed once all necessary x-rays have been taken.

After the Procedure

• You will be brought to the recovery room for observation following the treatment. You will be brought to your hospital room or discharged to your home if your blood pressure, pulse, and respiration are stabilized and you are conscious. If this surgery was performed as an outpatient, you should arrange for someone else to transport you home.
• You are not permitted to eat or drink anything until your gag reflex returns. For a few days, you may experience throat irritation and swallowing pain. This pain is typical.
• To help clear your airways, you may be asked to gently cough up and spit any remaining contrast dye into a basin. Postural drainage may be suggested by the doctor (lying flat with the head lower than the rest of the body while the physician or nurse gently pats your back to help drain the secretions).
• Unless your doctor tells you differently, you can resume your normal diet after the surgery. It is possible that you will be recommended to wait 24 hours before returning to your normal activities.
• Following the operation, your throat may feel hoarse. Your doctor may advise you to use a throat lozenge or spray.
• A chest x-ray may be taken 24 to 48 hours after the procedure to see if the contrast dye has been removed from the airways.

Notify your physician to report any of the following:

• Fever and/or chills for longer than two to three days after the procedure
• Redness, swelling or bleeding or other drainages from the IV site
• Extreme hoarseness or difficulty breathing

References

• Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013