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Figurę 3.22 Chest X-rays in COPD

Chest X-ray is rarely itself diagnostic for COPD - but is valuable in excluding alternative diagnoses and for detecting complications (infection, pneumothorax. malignancy, heart failure. pulmonary embolism)

Mild COPD Chest X-ray is usually normal	Chronić bronchitis •    'Dirty lung' •    Increased lung markings •    Bronchial wali thickening
Emphysema
•    Oligemia •    Loss of fine vasculature markings. especially at the periphery of the lung where there is rapid tapering of vascular markings •    Bulla: areas of translucency surrounded by thin wali	f nypenmiation •    Large volume hyperlucent lungs - darker •    Low, fiat diaphragm on lateral film/PA •    Thin heart shadow •    Enlarged retrosternal air space on the lateral view

Pulmonary hypertension and cor pulmonale

•    Hilar va$culature becomes prominent

•    Descending branch of right pulmonary artery > 20 mm

•    Cardiomegaly - reflecting right ventricular hypertrophy