Authors: Shayan Hemmati COPD: Findings on Posterior-Anterior and Lateral Chest X-ray Findings Reviewers: Reshma Sirajee, Sravya Kakumanu, Tara Shannon, *Stephanie Nguyen, *MD at time of publication
Chronic Obstructive Pulmonary Disease (COPD) See Pathogenesis of COPD Slides
Findings of COPD may not be apparent on chest X-ray early within the disease
Lung inflammation causes proteolytic destruction of lung parenchyma (part of lungs involved in gas exchange)
Alveolar walls are damagedàformation of fragile enlarged sacs of air called bullae
Rupture of bullae due to weak alveolar walls
Air leaves alveola and enters pleural space
Pneumothorax
See Primary Spontaneous Pneumothorax slide
Vasoconstriction of pulmonary arteries to shunt blood to better ventilated areas
Pulmonary hypertension
See Pathogenesis of Pulmonary Hypertension slide
↑ Pressure within pulmonary arteries
Enlargement of pulmonary arteries
Hilar enlargement Lung hyperinflation
(defined as 10 posterior ribs above the diaphragm level on the midclavicular line)
↑ Lucency of the lung
field, ↓ lung markings
(unless COPD is of chronic bronchitis phenotype)
↑ Size of retrosternal airspace
↑ Anterior – posterior (AP) diameter (“Barrel Chest”)
Flattening of hemidiaphragms
12 3 4
5 6
7
8
9 10
Poorly ventilated areas of lung
Hyperinflation as air becomes trapped in damaged lungs
↑ Total volume of air within the chest
Airway fibrosisà bronchial wall thickening (yellow arrow heads)
Air is less dense than soft tissue and vessels so it appears black
↑ Pressure anteriorly on sternum
↑ Pressure posteriorly on thoracic wall
↑ Pressure posteriorly on diaphragms
PA
Bullae sometimes visible on X-ray (focal areas of lucency with spread out vascular markings)
Image credit: Bronchial wall thickening image courtesy of Dr. Ashley Davidoff
Image credit: Radiopaedia
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published October 26, 2022 on www.thecalgaryguide.com