Case contributed by Ian Bickle
Diagnosis almost certain


Retired female, heavy smoker. Shortness of breath on exertion.

Patient Data

Age: 66
Gender: Female

The lungs are markedly hyperinflated.

Flattening of the diaphragm.

Bullous change in the left upper lobe.

The heart has an elongated appearance.

Case Discussion

Emphysema is one end of the spectrum of findings in COPD.  The disease is usually quite pronounced by the time the typical appearances are evidence on a plain radiograph.

In this case the hyperinflated nature of the lungs is very readily apparent. The lucency and sparsity of bronchovascular markings in the upper left hemithorax indicates the disease is most pronounced in the left upper lobe.

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