Chronic obstructive lung disease ( COPD) / Emphysema

What is COPD?

Emphysema, Chronic bronchitis and refractory asthma comprise COPD.

Describe the characteristic pathologic changes in emphysema.

Destruction of septal walls of alveoli
Loss of elastic recoil
Destruction of vascular bed
Fusion of adjacent alveoli producing large abnormal airspaces (blebs or bullae).

Emphysema


Note the clusters of dilated air spaces which are conspicuous in the middle and lower lobes of the right lung and the lower lobe of the left lung. Both lungs are markedly enlarged.	Normal lungs

What are the anticipated findings of COPD in CXR?

Hyperinflation is the common finding in all three conditions presenting as COPD.
Most of the times they are indistinguishable.
Bullae and avascularity in the peripheral third of lung are findings in emphysema.

What are the x-ray findings of emphysema?

Lungs are large and hyper inflated.
Signs of hyperinflation are
- Low set diaphragm
- Flat diaphragm best determined by lateral chest
- Hyper lucent lung fields
- Increased AP diameter
- Increased retro-sternal air
- Vertical heart
Signs of hyperinflation can be seen in emphysema, chronic bronchitis and asthma.
We can call it emphysema only when hyperinflation is associated with blebs and paucity of vascular markings in the outer third of the film.

Lateral chest is best to evaluate flattening of diaphragm, AP diameter and retrosternal air.