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copd-findings-on-posterior-anterior-and-lateral-chest-x-ray-findings

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