A technique of bronchography in children with evaluation of contrast media.

Since 1947 an intensive study of endobronchial tuberculosis in children has been undertaken in the Chest Clinic of the Children’s Medical Service of Bellevue Hospital.1’ An attempt was made to determine by means of bronchography the incidence and types of residual bronchial and pulmonary disease in children previously found to have tuberculous endobronchial lesions on bronchoscopy. During 1955-56, 117 bronchograms were made in children with apparently healed endobronchial disease; in addition, seven bronchograms were carried out in children with non-tuberculous pulmonary disease, making a total of 124 bronchograms. This investigation has provided an unusual opportunity to evaluate methods of bronchography in children, also three commonly used contrast media. In recent years, bronchography has been used with greater frequency as an aid in the diagnosis and localization of pulmonary disease. However, its use in children has been limited, due to certain technical difficulties. Various methods for the introduction of the contrast medium have been used, such as supraglottic,3 transglottic4 and subglottic#{176} routes. Different. techniques of anesthesia have been tried, using local anesthetics,7 general anesthetics or a combination of both.4’ 8 Our satisfactory results in 110 out of 124 bronchograms (88 per cent) compare favorably with the other accurately reported series of bronchograms in children, namely that of Bates and his associates,5 who obtained good bronchograms in 41 out of 50 cases (82 per cent) in 1950. We attribute our good results particularly to the following factors: a) anesthesia, b) type and amount of contrast medium used, c) careful and systematic positioning of the patient following fractional instillation of the contrast medium, and d) radiographic technique.