|Once upon a time there were two men who had gone cliff climbing. Suddenly, one man lost his footing and went tumbling down to the bottom. The other man frantically screamed, "Roger!", and was relieved to hear a faint reply. "Okay Rodge," shoute... Read more of Idiot resuce at Free Jokes.ca|| Informational|
Medical ArticlesPathologic Physiology
The development of permanent injury to one or more valves o...
Our Relations With Others
EVERY one will admit that our relations to others sho...
Some things regarding this useful fruit require to be noted by...
There is a common and very popular error, namely, that of putt...
Treatment Of Endocarditis
As mild endocarditis rarely occurs primarily but is almost al...
Persons suffering from nervous prostration have probably allow...
The Surgical Dissection Of The Sterno-clavicular Or Tracheal Region And The Relative Position Of Its Main Bloodvessels Nerves &c
The law of symmetry governs the development of all structures...
For slight bruises, such as children frequently get by falling...
See Dropsy. ...
I KNOW a woman who says that if she wants to get her ...
The most striking symptom of diphtheria is the growth of a sub...
Practice On The Dog
Having mastered the technic of introduction on the cadaver a...
Active and persistent antiluetic medication must precede and ...
Eyes Paralysis Of
The partial paralysis of the muscles of one eye produces doubl...
Resume Of After-care Of A Tracheotomic Case
1. Always bear in mind that tracheotomy is not an ultimate ...
The Development Of My Own Constipation
The history of my own constipation, though it especially rela...
The key to action in case of epidemics prevailing in the distr...
Mechanical Effect Of Each Pole
The mechanical effect of the forward end of the current, or t...
The symptoms are increased tension, which means, sooner or la...
Medicinal Runic Inscriptions
The discovery of the script of the ancient Germans, suppose...
The Roentgenographic Signs Of Expiratory-valve-like Bronchial Obstruction
Category: FOREIGN BODIES IN THE AIR AND FOOD PASSAGES
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The roentgenray signs in expiratory valve-like obstruction of a
bronchus are those of an acute obstructive emphysema (Fig. 74),
1. Greater transparency on the obstructed side (Iglauer).
2. Displacement of the heart to the free side (Iglauer).
3. Depression and flattening of the dome of the diaphragm on the
invaded side (Iglauer).
4. Limitation of the diaphragmatic excursion on the obstructed side
It is very important to note that, as discovered by Manges, the
differential emphysema occurs at the end of expiration and the plate
must be exposed at that time, before inspiration starts. He also noted
that at fluoroscopy the heart moved laterally toward the uninvaded
side during expiration.*
* Dr. Manges has developed such a high degree of skill in the
fluoroscopic diagnosis of non-opaque foreign bodies by the obstructive
emphysema they produce that he has located peanut kernels and other
vegetable substances with absolute accuracy and unfailing certainty in
dozens of cases at the Bronchoscopic Clinic.
[FIG. 74--Expiratory valve-like bronchial obstruction by
non-radiopaque foreign body, producing an acute obstructive emphysema.
Peanut kernel in right main bronchus. Note (a) depression of right
diaphragm; (b) displacement of heart and mediastinum to left; (c)
greater transparency of the invaded side. Ray-plate made by Willis F.
Complete bronchial obstruction shows a density over the whole area
the aeration and drainage of which has been cut off (Fig. 75).
Pulmonary abscess formation and drowned lung (accumulated secretion
in the bronchi and bronchioli) are shown by the definite shadows
produced (Fig. 76).
 Dense and metallic objects will usually be readily seen in the
roentgenograms and fluoroscope, but many foreign bodies are of a
nature which will produce no shadow; the roentgenologist should,
therefore, be prepared to interpret the pulmonary pathology, and
should not dismiss the case as negative for foreign body because one
is not seen. Even metallic objects are in rare cases exceedingly
difficult to demonstrate.
[FIG. 75.--Radiograph showing pathology resulting from complete
obstruction of a bronchus with atelectasis and drowned lung resulting.
Foot of an alarm clock in left bronchus of 4 year old child. Present
25 days. Plate made by Johnston and Grier.]
Positive Films of the Tracheo-bronchial Tree as an Aid to
Localization.--In order to localize the bronchus invaded by a small
foreign body the positive film is laid over the negative of the
patient showing the foreign body. The shadow of the foreign body will
then show through the overlying positive film. These positive films
are made in twelve sizes, and the size selected should be that
corresponding to the size of the patient as shown by the
roentgenograph. The dome of the diaphragm and the dome of the pleura
are taken as visceral landmarks for placing the positive films which
have lines indicating these levels. If the shadow of the foreign body
be faint it may be strengthened by an ink mark on the
uncoated side of the plate.
[FIG. 76.--Partial bronchial obstruction for long period of time
Pathology, bronchiectasis and pulmonary abscess, produced by the
presence for 4 years of a nail in the left lung of a boy of 10 years]
Bronchial mapping is readily accomplished by the author's method of
endobronchial insufflation of a roentgenopaque inert powder such as
bismuth subnitrate or subcarbonate (Fig. 77). The roentgenopaque
substance may be injected in a fluid mixture if preferred, but the
walls are better outlined with the powder (Fig. 77).
[FIG. 77.--Roentgenogram showing the author's method of bronchial
mapping or lung-mapping by the bronchoscopic introduction of opaque
substances (in this instance powdered bismuth subnitrate) into the
lung of the patient. Plate made by David R. Bowen. (Illustration,
strengthened for reproduction, is from author's article in American
Journal of Roentgenology, Oct., 1918.)]
Next: Errors To Avoid In Suspected Foreign Body Cases
Previous: Roentgenray Study In Foreign Body Cases