Chest X-Ray in COPD is often normal. Even in advanced disease chest X-ray can be normal.
But if the following signs are found in a chest X-Ray then they will be highly suggesting of COPD.


  1. Hyperinflation of lungs. Hyperinflation of lungs can be identified with the help of physical examination or chest X-Ray. On physical examination, you may find upper border of liver displaced down and a barrel-shaped chest. While on chest X-Ray you may find hyper lucent lungs, flattening of hemi-diaphragms, and seven or more anterior ribs are seen over the lung shadow. 
  2. Pruning of Vessels: Central vessels are more prominent while less blood is seen in peripheral lung fields. 
  3. Large Bullae
It is not necessary for a patient with COPD to have all of the above signs, as it has been mentioned earlier, the chest x-ray can be normal even when the disease is advanced, therefore, if you notice any of the above sign in a chest x-ray, then you may consider COPD as a differential in the absence of documented history or examination findings. 


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