Thursday, 21 May 2009

Case 2: the answer

Thanks to those who put forward their prospective answers, either via email or in the comments section.  This was the X-ray of a 65-year-old smoker.

The X-ray shows three notable things:
  • The anterior-posterior diameter of the chest looks enlarged and "barrel-shaped".
  • There is an increase in the amount of air 'trapped' anterior to the cardiac shadow.
  • The diaphragms are flattened.
Together these point to generalised hyperinflation.  On the AP (or PA) view you would presumably see an increase in the number of ribs visible.

There are several causes of generalised hyperinflation, but the most likely of these, in a 65-year-old smoker, is chronic obstructive pulmonary disease (COPD).  Other possibilities for generalised hyperinflation are:
  • Asthma (when symptomatic)
  • Cystic fibrosis
  • ╬▒1-antitrypsin deficiency
  • endobronchial sarcoidosis

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