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Medical ArticlesAcute Mild EndocarditisThis inflammation of the endocardium is generally confined to... Bleeding In any case of this pack the feet and legs as directed in Lung... Changing Treatment To wisely alter and arrange the treatment in any case is of th... Measles This is a contagious disease, and always begins with symptoms... Irritable Husbands SUPPOSE your husband got impatient and annoyed with y... Blood Supply Of To supply good blood in cases where it is lacking, either from... Illustrations I shall give a couple of illustrations: In the winter of 1... Removal Of Double Pointed Tacks If the tack or staple be small, and lodged in a relatively l... Sugars Where Sugar is Obtained. The other great member of the starch... Cardiovascular Renal Disease Treatment While it is urged, in preventing the actual development of th... In Excessive Heat And Continuous Delirium A Half-bath May Be Given also, every time the packing sheet is changed. The rule is that... Treatment Of Acute And Subacute Inflammation And Ulceration Of The Esophagus Bismuth subnitrate in doses of about one gramme, given dry o... Punctures Case Xiii Am old man applied leeches to the instep for inflammation occ... Scarlatina Anginosa Or Sore-throat Scarlet-fever Wherever the _throat_ is affected, which is almost always the... Bowels Locking Of Sometimes when one part of the bowels is much more active than... Hooping Cough According to my experience, though this disease may not be en... Leucorrhoea And Prolapsus Uteri - Whites Female Weakness The disease depends in all cases upon _inflammation_ of the u... Prognosis And Convalescence The duration of acute endocarditis varies greatly; it may be ... Contraindications There is no absolute contraindication to careful esophagosco... Acidity Of The Stomach Often caused by unwholesome food, bad or deficient teeth, or b... |
The Roentgenographic Signs Of Expiratory-valve-like Bronchial ObstructionCategory: 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), namely, 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 (Manges). 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. Manges.] 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). [140] 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
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