ABSTRACT
The chest radiograph is often normal in patients with mild COPD. With the development of hyperinflation, frontal and lateral views demonstrate an increased AP diameter, flat tening of the hemidiaphragms, and increased size of the retrosternal space. In patients with complicating pulmonary hypertension and right ventricular failure, enlargement of the main pulmonary arteries and encroachment of the right ventricle on the retrosternal space is seen. The radiographic hallmarks of emphysema are hyperlucency of the lungs and the presence of bullae, radiolucent areas bordered by thin rims of lung parenchyma. Although usually evident in patients with severe emphysema, these findings are often absent in the setting of mild to moderate disease.
