Book contents
- Frontmatter
- Contents
- List of abbreviations
- Part I Fundamentals of CXR interpretation – ‘the basics’
- Part II A–Z Chest Radiology
- Abscess
- Achalasia
- Alveolar microlithiasis
- Aneurysm of the pulmonary artery
- Aortic arch aneurysm
- Aortic rupture
- Asbestos plaques
- Asthma
- Bochdalek hernia
- Bronchiectasis
- Bronchocele
- Calcified granulomata
- Carcinoma
- Cardiac aneurysm
- Chronic obstructive pulmonary disease
- Coarctation of the aorta
- Collapsed lung
- Consolidated lung
- Diaphragmatic hernia – acquired
- Diaphragmatic hernia – congenital
- Embolic disease
- Emphysematous bulla
- Extrinsic allergic alveolitis
- Flail chest
- Foregut duplication cyst
- Foreign body – inhaled
- Foreign body – swallowed
- Goitre
- Haemothorax
- Heart failure
- Hiatus hernia
- Idiopathic pulmonary fibrosis
- Incorrectly sited central venous line
- Kartagener syndrome
- Lymphangioleiomyomatosis
- Lymphoma
- Macleod's syndrome
- Mastectomy
- Mesothelioma
- Metastases
- Neuroenteric cyst
- Neurofibromatosis
- Pancoast tumour
- Pectus excavatum
- Pericardial cyst
- Pleural effusion
- Pleural mass
- Pneumoconiosis
- Pneumoperitoneum
- Pneumothorax
- Poland's syndrome
- Post lobectomy/post pneumonectomy
- Progressive massive fibrosis
- Pulmonary arterial hypertension
- Pulmonary arteriovenous malformation
- Sarcoidosis
- Silicosis
- Subphrenic abscess
- Thoracoplasty
- Thymus – malignant thymoma
- Thymus – normal
- Tuberculosis
- Varicella pneumonia
- Wegener's granulomatosis
Chronic obstructive pulmonary disease
Published online by Cambridge University Press: 25 February 2010
- Frontmatter
- Contents
- List of abbreviations
- Part I Fundamentals of CXR interpretation – ‘the basics’
- Part II A–Z Chest Radiology
- Abscess
- Achalasia
- Alveolar microlithiasis
- Aneurysm of the pulmonary artery
- Aortic arch aneurysm
- Aortic rupture
- Asbestos plaques
- Asthma
- Bochdalek hernia
- Bronchiectasis
- Bronchocele
- Calcified granulomata
- Carcinoma
- Cardiac aneurysm
- Chronic obstructive pulmonary disease
- Coarctation of the aorta
- Collapsed lung
- Consolidated lung
- Diaphragmatic hernia – acquired
- Diaphragmatic hernia – congenital
- Embolic disease
- Emphysematous bulla
- Extrinsic allergic alveolitis
- Flail chest
- Foregut duplication cyst
- Foreign body – inhaled
- Foreign body – swallowed
- Goitre
- Haemothorax
- Heart failure
- Hiatus hernia
- Idiopathic pulmonary fibrosis
- Incorrectly sited central venous line
- Kartagener syndrome
- Lymphangioleiomyomatosis
- Lymphoma
- Macleod's syndrome
- Mastectomy
- Mesothelioma
- Metastases
- Neuroenteric cyst
- Neurofibromatosis
- Pancoast tumour
- Pectus excavatum
- Pericardial cyst
- Pleural effusion
- Pleural mass
- Pneumoconiosis
- Pneumoperitoneum
- Pneumothorax
- Poland's syndrome
- Post lobectomy/post pneumonectomy
- Progressive massive fibrosis
- Pulmonary arterial hypertension
- Pulmonary arteriovenous malformation
- Sarcoidosis
- Silicosis
- Subphrenic abscess
- Thoracoplasty
- Thymus – malignant thymoma
- Thymus – normal
- Tuberculosis
- Varicella pneumonia
- Wegener's granulomatosis
Summary
Characteristics
General term encompassing a spectrum of conditions including chronic bronchitis and emphysema.
Characterised by chronic resistance to expiratory airflow from infection, mucosal oedema, bronchospasm and bronchoconstriction, due to reduced lung elasticity.
Causative factors include smoking, chronic asthma, alpha-1 antitrypsin deficiency and chronic infection.
Clinical features
Exacerbations commonly precipitated by infection.
Cough, wheeze and exertional dyspnoea.
Tachypnoea, wheeze, lip pursing (a form of PEEP), use of accessory muscles.
Cyanosis, plethora and signs of right heart failure suggest severe disease and cor pulmonale.
Signs of hypercarbia include coarse tremor, bounding pulse, peripheral vasodilatation, drowsiness, confusion or an obtunded patient.
Radiological features
CXR – only moderately sensitive (40–60%), but highly specific in appearance. Is an easily accessible method of assessing the extent and degree of structural parenchymal damage.
Assessment for complications such as pneumonia, lobar collapse/atelectasis, pneumothorax or mimics of COPD.
CXR features include hyper-expanded lungs with associated flattening of both hemi-diaphragms, ‘barrel-shaped chest’, lung bullae, coarse irregular lung markings (thickened dilated bronchi) and enlargement of the central pulmonary arteries in keeping with pulmonary arterial hypertension.
REMEMBER to look for lung malignancy/nodules; a common association.
CT – quantifies the extent, type and location of emphysema and bronchial wall thickening. It may also identify occult malignancy.
Differential diagnosis
Lymphangioleiomyomatosis (LAM) and Langerhan's cell histiocytosis (LCH) can have a similar CXR and CT appearance. The clinical history and imaging together are diagnostic.
Asthma ± superimposed infection.
Extrinsic allergic alveolitis.
Viral infections.
Management
Supplemental oxygen tailored to keep pO2 > 7.5 kPa. Beware high concentrations of supplemental pO2, as patients fail to expel the CO2 and develop high pCO2 levels.
[…]
- Type
- Chapter
- Information
- A-Z of Chest Radiology , pp. 62 - 65Publisher: Cambridge University PressPrint publication year: 2007