TAILIEUCHUNG - Ebook Fast facts - Chronic obstructive pulmonary disease (3/E): Part 2

Part 2 book “Fast facts - Chronic obstructive pulmonary disease” has contents: Imaging, smoking cessation, therapy in stable disease, aute exacerbations, future trends. Invite to references. | 5 Imaging No features specific for COPD are seen on a plain posterior–anterior chest radiograph. The features usually described are those of severe emphysema. However, there may be no abnormalities, even in patients with very appreciable disability. Recent improvements in imaging techniques, particularly the advent of CT and, more recently, high-resolution CT (HRCT), have provided more sensitive means of diagnosing emphysema in life. Plain chest radiography The most reliable radiographic signs of emphysema can be classified by their causes of overinflation, vascular changes and bullae. Overinflation of the lungs results in the following radiographic features: • a low flattened diaphragm (Figure ): the diaphragm is abnormally low if the border of the diaphragm in the midclavicular line is at or below the anterior end of the seventh rib; and the diaphragm is flattened if the perpendicular height from a line drawn between the costal and cardiophrenic angles to the border of the diaphragm is less than cm • increased retrosternal airspace, visible on the lateral film at a point 3 cm below the manubrium when the horizontal distance from the posterior surface of the aorta to the sternum exceeds cm • an obtuse costophrenic angle on the posterior–anterior or lateral chest radiograph • an inferior margin of the retrosternal airspace 3 cm or less from the anterior aspect of the diaphragm. Vascular changes associated with emphysema result from loss of alveolar walls and are shown on the plain chest radiograph by: • a reduction in the size and number of pulmonary vessels, particularly at the periphery of the lung • vessel distortion, producing increased branching angles, excess straightening or bowing of vessels 74 • areas of transradiancy. © 2016 Health Press Ltd. Imaging (a) (b) Figure Plain chest radiographs of generalized emphysema particularly affecting the lower zones. (a) Posterior–anterior radiograph showing a low, .

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