Lung angiography. Pulmonary angiography Pulmonary angiopulmonography

Pulmonary angiography today is one of the most accurate methods for studying blood flow in the lungs and the state of their vessels. it x-ray method research in which in vascular system lungs injected contrast agent, which makes it possible to visualize blood vessels with X-ray, assess their patency, the presence of blood clots, the condition of the walls of arteries and veins.

Despite all the advantages of this research method, there are several of its disadvantages, namely, vascular puncture (invasive method) and X-ray radiation exposure.

Indications for

Given the invasiveness of the technique with puncture of blood vessels, the lungs are performed according to strict indications for such pathological conditions:

• neoplasms in the lungs - any tumor process is not accompanied by pain, with a small tumor, it is practically impossible to identify it non-invasively instrumental methods studies (plain radiography, cT scan), therefore, angiography of the lungs makes it possible to determine the localization and size of the neoplasm by changing the vascular pattern;
• intrapulmonary bleeding - with the help of angiography, it is possible to clearly determine the localization of bleeding, its intensity and the caliber of the damaged vessel, which makes it possible to start early treatment;
• pulmonary embolism (BODY) - a condition in which a blood clot gets stuck in one of the branches of the pulmonary artery, blocking its lumen, pulmonary angiography makes it possible to determine the location of the thrombus, the degree of vascular occlusion, usually performed in parallel with therapeutic measures, namely the introduction of heparin into the artery, due to which the thrombus is absorbed.

Contraindications to angiography

Despite the informativeness of pulmonary angiography, there are certain contraindications to its conduct:

1. an allergic reaction to the introduction of a contrast agent, especially to iodine-containing drugs;
2. individual intolerance to contrast medium;
3. acute myocardial infarction;
4. cardiac arrhythmias - arrhythmias;
5. chronic diseases internal organs in the stage of decompensation;
6. acute or chronic renal failureat which the removal of the contrast agent from the body stops;
7. heavy mental pathology in the acute stage (relapse);
8. refusal of the patient to carry out this diagnostic procedure.

An important point is that the performance of pulmonary angiography can be carried out for health reasons with pulmonary embolism, even in the presence of the above contraindications.

Types and preparation for the procedure

Depending on the caliber of the vessel into which the contrast agent is injected, the following types are distinguished:

1. general (overview) - a contrast agent is injected directly into the right ventricle of the heart or pulmonary artery, while the state of all vessels of the lungs is determined on the roentgenogram;
2. selective (selective) angiography - in this case, a contrast agent is injected into an artery of a smaller caliber, which feeds a limited area of \u200b\u200bthe lungs - a lobe or segment.

Preparation begins one day before the study and includes the following stages:

• administering sedatives (tranquilizers) to the patient the night before pulmonary angiography to relieve anxiety and emotional stress;
• diphenhydramine is introduced immediately before the study, it allows to reduce pain from the puncture of the vessel and reduce possible allergic reactions to the contrast agent;
• the study is carried out on an empty stomach, therefore, the night before and in the morning of the study, food intake is undesirable.

Research methodology

Before performing a puncture of the artery, the anesthesiologist performs local anesthesia of the skin with an anesthetic. Then a special needle with a catheter is used to puncture the vessel and insert the catheter into it. After removing the needle, the doctor injects a certain amount of contrast agent through the catheter.

The radiologist, immediately after filling the vessels of the lungs with a contrast agent, performs a series of radiographs. The resulting images are deciphered with the participation of a radiologist and a pulmonologist. During this procedure, a cardioreanimatologist must be present.

To prevent infection of the patient, the study is carried out under aseptic conditions with sterile disposable instruments and only with the written consent of the person being examined.

Pulmonary angiography is performed to assess the state of blood flow in these organs. This method is recognized as one of the most effective and accurate when it comes to examining the vessels of the lungs.

Indications

Pulmonary angiography is prescribed according to strict indications:

1. Neoplasms. As a rule, small tumors are almost impossible to detect with non-invasive methods, so angiography is a priority in such cases. It allows you to localize formations and establish their size.
2. Intrapulmonary bleeding. Angiographic examination will help not only indicate the exact location of the bleeding, but also indicate the degree of its intensity and damage, which will determine the choice of a further course of treatment.
3. BODY, or pulmonary embolism, is the formation of a blood clot that clogs a branch of an artery in the lung. In such cases, angiography is performed not only for diagnostic purposes (it determines the localization and size of the thrombus), but is also the beginning of treatment: heparin is also injected into the artery, which promotes resorption of the thrombus.

Types of procedure

There are two types of pulmonary angiography:

1. General, or overview. The contrast agent is injected into the right ventricle of the heart or the pulmonary artery. The X-ray shows the state of all vessels in the examined organs.
2. Selective or selective. The contrast is injected into a smaller artery feeding a single segment of the lungs. In this case, a more detailed study of a specific section of the organ takes place.

In addition, depending on the location, there are 2 types of procedures:

1. Angiopulmonography. The pulmonary trunk and its branches are examined. It is used for suspected lung tumors and malformations, as well as thromboembolism.
2. Bronchial arteriography examines the arteries that feed the lung. It is performed with pulmonary bleeding of unknown origin and localization, congenital defects heart magnification lymph nodes, in the diagnosis of tumors and inflammatory processes. This type of angiography is most often done through the femoral artery.

Procedure

After puncture and insertion of the catheter, a contrast agent is injected. Then an X-ray is carried out: images of blood vessels with contrast. The images taken are discussed by the pulmonologist and radiologist involved in the procedure. In addition, a cardioreanimatologist must be present at the angiography, who monitors the heart rate, since the catheter can cause arrhythmias.

The cost

The average cost of pulmonary angiography varies from 12,000 to 18,000 rubles.

Lung angiography- This is an X-ray examination using a special dye and a camera (fluoroscope) to record the process of blood supply in the vessels of the lungs.

During lung angiography, a thin tube (catheter) is inserted into a femoral vein in the groin or just above the elbow into the brachial vein. The catheter is inserted into the area to be examined. An iodine dye (contrast agent) is then injected into the vessel to clearly display the target area on X-ray images. Angiography uses both conventional X-ray film and digital images for storage in a computer.

Why is angiography performed?

Pulmonary angiography is used for research pulmonary arteries and blood vessels. It detects narrowing or blockages in blood vessels that slow or stop circulation. Angiography is also performed to measure the pressure in the vessels.

2. How to prepare for angiography?

Before having a pulmonary angiography, tell your doctor the following:

• About the presence of pregnancy (as a rule, this is a contraindication for the test).
• ABOUT breastfeeding... Use formula milk (not breast milk) for 1 to 2 days after angiography until the dye is released from your body. This process takes approximately 24 hours.
• Allergy to iodide dye used in the study.
• Have you had a severe allergic reaction (anaphylaxis) to a substance, such as a bee sting or eating seafood?
• About the presence of asthma.
• Allergies to any medications.
• Bleeding or taking blood thinners.
• Kidney problems or diabetes, especially if you are taking metformin (such as Glucophage) to lower your blood sugar. The dye used during angiography can cause kidney damage in these patients.

Do not eat or drink 4 to 8 hours before pulmonary angiography. Do not take aspirin or blood thinners for several days before the test and one day after. Angiography can be done in a hospital or on an outpatient basis.

3. How is angiography performed?

Vascular angiography of the lungs is performed by various specialists - a radiologist, cardiologist or surgeon. The doctor, if necessary, will supply an IV for the delivery of medicines and fluids. Pulse Oximeter, which measures the level of oxygen in the blood connected to your finger or ear. Small discs (electrodes) are placed on your arms, chest, or legs to record your heart rate. A lead apron is used to protect the genitals from X-rays. The circular cylinder or rectangular block that takes the pictures will move above you and the fluoroscope from below.

The place where the catheter will be inserted (groin or above the elbow) will be shaved, disinfected, and then numbed. After that, the needle is inserted into the blood vessel. A guidewire and catheter are then inserted through the needle. It is injected until it reaches the examination area. The doctor will use a fluoroscope to observe the movement of the catheter in the blood vessels.

Next, a dye is injected through the catheter. You will be asked to hold your breath for a few seconds. Several X-rays will be taken. You need to lie still so that the image is clear. The entire lung angiogram procedure takes 1 to 2 hours.

After pulmonary angiography, the catheter is removed. The doctor will stop possible bleeding. Then a bandage is applied and an anesthetic drug is given.

4. What are the sensations and risks during pulmonary angiography?

How does it feel during pulmonary angiography?

You may feel a slight tingling sensation from the anesthesia being administered. Most people do not feel pain when the catheter is in blood vessel... You may feel pressure in a blood vessel while moving the catheter. Tell your doctor if you experience pain.

You will probably feel warm when you start to inject the dye. It only takes a few seconds. Try to control your cough and hold your breath for a few seconds.

When using a dye, headache, facial flushing, salty or metallic taste in the mouth. This takes a short time. Some patients may feel a heavy stomach or vomit, but this is rare. After the examination, a small bruise may appear at the site of the catheter insertion. You will need to consume more fluids to remove the dye from your body faster.

Risks of Lung Angiography

Complications with pulmonary angiography are rare, but sometimes they do. In most cases, problems occur within 2 hours after the procedure, when you are in the recovery room. If any difficulties arise during angiography, the test is stopped.

With pulmonary angiography, there is a possibility allergic reaction on iodine in dye. The reaction can be mild (itching, rash) or severe (trouble breathing or sudden shock). Most reactions are blocked by medicines... Be sure to tell your doctor if you have hay fever, asthma, food allergy or iodine allergy.

There may be bleeding from the injection site. In addition, blood clot at the site of insertion of the catheter, which will obstruct blood circulation.

The use of iodine can lead to water loss in the body or kidney damage. This applies to people with kidney disease, diabetes, or dehydration. For these patients, measures are taken to prevent kidney damage. Use less dye or more liquid. If you have kidney disease, doctors do a preliminary blood test (for creatinine, blood urea nitrogen) to make sure your kidneys are working properly.

With lung angiography, there is a small chance of damage to cells or tissues from exposure to any radiation, even the low level used in this test.

Alternative tests

Computed tomography (CT) or magnetic resonance angiography (MRA) may be alternative options for examining the vessels. Each of these tests is less invasive than a standard lung angiography procedure.

ANGIOPULMONOGRAPHY (Greek angeion - vessel, Latin pulmo - light and Greek grapho - I write, depict; synonym: angiopneumography, lung angiography) - X-ray examination of the branches of the pulmonary artery after contrasting.

Angiopulmonography is indicated if there is a suspicion of pulmonary malformations, pulmonary vascular lesions, pulmonary embolism, and also in order to clarify the operability of patients and determine the functional usefulness lung tissue... Angiopulmonography is contraindicated in case of intolerance to iodine preparations, severe kidney and liver failure, insufficiency of the cardiac conduction system, phlebitis, pronounced hypertension.

Two methods of angiopulmonography are used: general and selective; a kind of selective angiopulmonography is end pulmonary angiography.

For general angiopulmonography, a contrast agent in the amount of 50-70 ml is injected intravenously (usually through the cubital vein) or into the cavity of the right heart (see Angiocardiography) using a catheter inserted through the vein (Fig. 1). In selective angiopulmonography (Fig. 2), a contrast agent is injected into one of the branches of the pulmonary trunk; for this purpose, a catheter is passed through the right heart into the pulmonary trunk and further into the pulmonary artery. To contrast one lung, 20-30 ml of contrast agent is used, for the study of one zone - 10-15 ml.

Selective pulmonary angiography allows you to simultaneously measure the pressure in the cavities of the heart and pulmonary trunk and determine the degree of blood oxygen saturation. At end-pngiopulmonography, the catheter is inserted into one of the segmental branches of the pulmonary artery (Fig. 3), after which 5-8 ml of contrast medium is injected. In addition to the described techniques, angiopulmonography can be performed by percutaneous puncture of the femoral or subclavian vein according to the Seldinger method (followed by the introduction of a probe).

There are three phases of contrasting pulmonary vessels: arterial, lasting 3-5 seconds, capillary, or parenchymal, lasting 1-3 seconds, and venous, lasting 4-7 seconds. To study the pulmonary circulation, a series of images is carried out on a seriograph according to the following approximate program: 2 images in 1 second for 3 seconds, then 1 image in 1 second for 10 seconds.

For angiopulmonography, the same contrast agents are used as for other types of angiography. It is preferable to use triiodinated drugs, which have a higher contrast and are less toxic (triombrin, shpak, urocon, urografin, verografin and others).

Complications during angiopulmonography can be caused by trauma to the vessel during the introduction of the probe, partial or complete perforation of the heart wall, as well as the body's response to a contrast agent.

Bibliography: Mazaev PN, Voropaev MM and Kopeiko IP Angiopulmonography in the clinic of surgical lung diseases, M., 1965, bibliogr .; Rabkin I. X. X-ray examination of vessels of a small circle of blood circulation at mitral heart diseases, M., 1963; X-ray diagnostics of diseases of the heart and blood vessels, ed. M.A.Ivanitskaya, M., 1970; Tikhonov KB Angiography, L., 1962; Bolt W. u. Rink H. Die terminale Lungenstrombahn im normalen und im pathologischen Angiogramm, Fortschr. Röntgenstr., Bd 93, S. 21, 1960; Löffler L. u. Roth H. Die Arteriographie der Lunge und die Kontrastdarstellung der Herzhöhlen am lebenden Merischen, Lpz., 1955, Bibliogr .; Semisch R. u. a. Atlas der selektiven Lungenangiographie, Jena, 1958, Bibliogr .; Viallet P. e. a. Angiocardiopneumographie élargie, P. 1959, bibliogr.

E. V. Krivenko.

Lung angiography: what is it?

For an accurate and detailed study of the condition of the lungs and their vessels, such an x-ray examination as angiography is used. It is performed using a special contrast agent (based on iodine), which contributes to better visualization of the vessels. Angiography can be performed using conventional X-ray film or digital equipment, which allows you to save images on a computer.

The appointment of such a diagnostic procedure should be based on certain indications:

• There is a suspicion of a neoplasm in the lungs. For example, when an annual fluorographic study shows the presence of a darkening in the main respiratory organ, and the patient has certain health complaints (shortness of breath, weakness, and others), angiography may be prescribed to clarify the diagnosis.
• There is a suspicion of intrapulmonary bleeding (it can occur due to injuries, incorrect operations, and so on).
• The patient presents with symptoms of pulmonary embolism. In this case, angiography is performed not only as a diagnostic procedure, but also as a therapeutic operation, during which heparin is injected into the pulmonary artery, which promotes resorption of the thrombus.

Lung angiography process

Training

Since pulmonary angiography is such a procedure, after which a number of complications may arise, the doctor must tell the patient about them before performing it. Next, the patient signs a consent and is sent for examination:

• takes a blood test: general, biochemical, coagulogram, to determine the Rh factor;
• undergoes an electrocardiogram;
• passes.