Degenerative Disorders Cxr

CHRONIC OBSTRUCTIVE PULMONARY DISEASES(COPDs)

OVERVIEW

Introduction to COPDs

• Types/components of COPDs

Radiographic features

Introduction to COPDs

Refers to a group of disorders that cause chronic airways obstruction and breathing difficulties.

• Represents a spectrum of obstructive airway diseases.
• Includes two key components
• Chronic bronchitis(small air way disease)

Emphysema

Causes and risk factors of COPDs

The most common cause has historically been (and unfortunately continues to be) cigarette smoking It takes many years of smoking to develop COPD and as such typically patients are older adults.

There are however a number of other less common risk factors/etiologies, each with their own demographics. They include:

• Industrial exposure (e.G. Mining)
• Cystic fibrosis
• Alpha-1 antitrypsin deficiency
• Intravenous drug use (IVDU)
• Immune deficiency syndromes

Vasculitides and connective tissue disorders

Clinical presentation : Symptoms of COPD include:

• Dyspnea on exertion
• Wheezing
• Productive cough

Pursed-lip breathing and use of accessory respiratory muscle (shortness of breath)

1. Chronic bronchitis

This is the long-term inflammation of the bronchial tubes often due to the smoking or air pollution.

The pollutants irritate the mucous lining of the bronchial tree and increase the susceptibility to both bronchial and virus infections.

NOTE:

Chronic exposure to these respiratory irritants leads to hyperplasia of mucous glands hypertrophy of the smooth muscles, thickening of the bronchial wall.

Radiological findings of chronic bronchitis.

Findings of chronic bronchitis are non specific on chest radiography and includes:

Increased bronchovascular markings. pulmonary vessels and bronchial wall(thicker) may appear larger than normal(prominent).

Cardiomegaly

a)Cardiomegaly b)Lung marking

2. Emphysema

This is the condition in which the lungs alveoli(air sacs) become distended, usually from loss of the elasticity ,it characterized by an increase in the air spaces distal to the terminals of the bronchioles with the destruction of alveolar walls.

Radiological findings of emphysema

Lung Hyperinflation(lung enlargement): The lungs appears over- inflated with increased (lucency).

Flattened diaphragms :The diaphragms may appear lower than normal due to the hyperinflation of the lungs.

Blunting of the costophrenic angles , the sharp between the diaphragm and the rib cage is lost which is the hallmark of the emphysema.

Hyperlucency (Increased translucency): The lungs appear more black than usual due to the presence of air.

Small heart: The heart shadow may appear smaller than normal due to the large amount of air in the lungs.

Bullous changes: Air- filled pockets(bullae) may be visible in the lungs.

Barrel shape(increased in AP diameter): The chest appears wider from front to back, resembling a barrel on the lateral radiograph.

Emphysema

Bullous changes

Pulmonary fibrosis

Pulmonary fibrosis is the preferred general term for the permanent replacement of lung parenchyma by connective tissue and is typically associated with functional impairment.

A variety of insults cause focal or diffuse lung injury (mechanical, infectious, inflammatory, and iatrogenic). Lung repair culminates in fibrosis with volume loss and architectural distortion.

Radiological features/findings

In a chest X-ray, pulmonary fibrosis often presents with:

Reticular opacities: Small, irregular, and often seen as a network of lines. These reticular patterns tend to be more pronounced at the lung bases, particularly in the subpleural regions.

• Volume loss
• Traction bronchiectasis
• Honeycombing may also be observed

These are the most common finding, appearing as a network of lines within the lung tissue

Pulmonary fibrosis