Imaging in chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease is defined by irreversible airflow obstruction due to emphysematous destruction of the lung parenchyma and small airways remodeling. It is a heterogeneous disease affecting the airways and/or the parenchyma with different severity during the course of the disease. Obstructive lung diseases may be associated with a variety of pathologic findings, including emphysema, large and small airways abnormalities. Computed tomography has become the standard modality to objectively visualize lung disease. High resolution computed tomography (HRCT) can reveal morphologic abnormalities associated with obstructive lung disease with a greater accuracy than plain radiographs. HRCT is more sensitive than radiographs in showing emphysema, large airways abnormalities such as bronchiectasis, small airways abnormalities, such as bronchiolectasis and the tree-in-bud appearance, and abnormal ventilation including mosaic perfusion. This review will discuss imaging of the chest in patients with pulmonary emphysema. Definitions of types of emphysema within the framework of chronic obstructive pulmonary disease are given. The classic findings on the chest radiograph are described, and the advances in sensitivity and specificity achieved with computed tomography scanning are noted.