Chronic obstructive pulmonary disease - marked hyperinflation

Case contributed by Assoc Prof Frank Gaillard

Presentation

Chronic, worsening shortness of breath.

Patient Data

Age: 60 years
Gender: Female

Chest xrays demonstrates very marked hyperinflation of both lungs. Over 11 posterior ribs are seen, the diaphragms are flattened and there is enlargement of the retrosternal airspace.  Pulmonary vasculature not terribly distorted, although there is some prominence of the pulmonary arteries.  

Annotated image

Annotated images (different patient)

Lateral chest x-ray from a different (normal but well inflated) patient. 

The thickness of the space between the ascending aorta and the sternum is normally no more than 2.5cm. 

The normal dome of each hemidiaphragm should rise at least 1.5cm above a line connecting the costophrenic angle posteriorly and sternophrenic angle anteriorly

Case Discussion

This case demonstrates unequivocal and marked hyperinflation secondary to emphysema.

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