Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1973 Jan;28(1):15–23. doi: 10.1136/thx.28.1.15

Relation between abnormalities in the chest radiograph and changes in pulmonary function in chronic bronchitis and emphysema

G Simon 1, N B Pride 1, N L Jones 1, A C Raimondi 1
PMCID: PMC469986  PMID: 4685207

Abstract

Chest radiographs of 101 patients with chronic airflow obstruction were assessed for evidence of over-inflation (increased retrosternal space, low diaphragm, and increased total lung capacity), pulmonary hypertension (increase in size of heart and major pulmonary vessels) and attenuation of medium-sized pulmonary vessels. The radiological abnormalities were related to the alterations in pulmonary function.

When the position of the diaphragm was low or the retrosternal space was 4·5 cm or more the average FEV1 was below 1·0 litre, but severe impairment of the FEV1 could be present when the position and contour of the diaphragm were normal and the retrosternal space was 2·5 cm or less. The radiological method for estimating total lung capacity agreed well with the results obtained with body plethysmography, but there was not a close correlation between the standard radiological signs of over-inflation and a large total lung capacity.

When the radiograph showed widespread vascular attenuation as well as over-inflation the impairment in FEV1 and other tests of pulmonary function was considerably more severe than when the radiograph showed over-inflation alone. Severe reduction in transfer factor was usually associated with changes in the pulmonary vessels.

It is concluded that the radiological diagnosis of widespread emphysema can be made with confidence only when there is attenuation of pulmonary vessels as well as evidence of over-inflation. In attempting to diagnose emphysema in life all available clinical and functional data should be considered in conjunction with the radiographic appearances.

Full text

PDF
18

Images in this article

21Image
on p.21
21Image
on p.21
22Image
on p.22
22Image
on p.22

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BARNHARD H. J., PIERCE J. A., JOYCE J. W., BATES J. H. Roentgenographic determination of total lung capacity. A new method evaluated in health, emphysema and congestive heart failure. Am J Med. 1960 Jan;28:51–60. doi: 10.1016/0002-9343(60)90222-9. [DOI] [PubMed] [Google Scholar]
  2. BLAKEMORE W. S., FORSTER R. E., MORTON J. W., OGILVIE C. M. A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J Clin Invest. 1957 Jan;36(1 Pt 1):1–17. doi: 10.1172/JCI103402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BURROWS B., NIDEN A. H., BARCLAY W. R., KASIK J. E. CHRONIC OBSTRUCTIVE LUNG DISEASE. I. CLINICAL AND PHYSIOLOGIC FINDINGS IN 175 PATIENTS AND THEIR RELATIONSHIP TO AGE AND SEX. Am Rev Respir Dis. 1965 Apr;91:521–540. doi: 10.1164/arrd.1965.91.4.521. [DOI] [PubMed] [Google Scholar]
  4. BURROWS B., STRAUSS R. H., NIDEN A. H. CHRONIC OBSTRUCTIVE LUNG DISEASE. 3. INTERRELATIONSHIPS OF PULMONARY FUNCTION DATA. Am Rev Respir Dis. 1965 Jun;91:861–868. doi: 10.1164/arrd.1965.91.6.861. [DOI] [PubMed] [Google Scholar]
  5. Burrows B., Fletcher C. M., Heard B. E., Jones N. L., Wootliff J. S. The emphysematous and bronchial types of chronic airways obstruction. A clinicopathological study of patients in London and Chicago. Lancet. 1966 Apr 16;1(7442):830–835. doi: 10.1016/s0140-6736(66)90181-4. [DOI] [PubMed] [Google Scholar]
  6. CAMPBELL E. J., HOWELL J. B. Rebreathing method for measurement of mixed venous PCO2. Br Med J. 1962 Sep 8;2(5305):630–633. doi: 10.1136/bmj.2.5305.630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DUBOIS A. B., BOTELHO S. Y., BEDELL G. N., MARSHALL R., COMROE J. H., Jr A rapid plethysmographic method for measuring thoracic gas volume: a comparison with a nitrogen washout method for measuring functional residual capacity in normal subjects. J Clin Invest. 1956 Mar;35(3):322–326. doi: 10.1172/JCI103281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. GOLDMAN H. I., BECKLAKE M. R. Respiratory function tests; normal values at median altitudes and the prediction of normal results. Am Rev Tuberc. 1959 Apr;79(4):457–467. doi: 10.1164/artpd.1959.79.4.457. [DOI] [PubMed] [Google Scholar]
  9. Guyatt A. R., Alpers J. H., Hill I. D., Bramley A. C. Variability of plethysmographic measurements of airways resistance in man. J Appl Physiol. 1967 Feb;22(2):383–389. doi: 10.1152/jappl.1967.22.2.383. [DOI] [PubMed] [Google Scholar]
  10. Lennon E. A., Simon G. The height of the diaphragm in the chest radiograph of normal adults. Br J Radiol. 1965 Dec;38(456):937–943. doi: 10.1259/0007-1285-38-456-937. [DOI] [PubMed] [Google Scholar]
  11. Loyd H. M., String S. T., DuBois A. B. Radiographic and plethysmographic determination of total lung capacity. Radiology. 1966 Jan;86(1):7–14. doi: 10.1148/86.1.7. [DOI] [PubMed] [Google Scholar]
  12. Nicklaus T. M., Stowell D. W., Christiansen W. R., Renzetti A. D., Jr The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. Am Rev Respir Dis. 1966 Jun;93(6):889–899. doi: 10.1164/arrd.1966.93.6.889. [DOI] [PubMed] [Google Scholar]
  13. Nicklaus T. M., Watanabe S., Mitchell M. M., Renzetti A. D., Jr Roentgenologic, physiologic and structural estimations of the total lung capacity in normal and emphysematous subjects. Am J Med. 1967 Apr;42(4):547–553. doi: 10.1016/0002-9343(67)90054-x. [DOI] [PubMed] [Google Scholar]
  14. REID L., MILLARD F. J. CORRELATION BETWEEN RADIOLOGICAL DIAGNOSIS AND STRUCTURAL LUNG CHANGES IN EMPHYSEMA. Clin Radiol. 1964 Oct;15:307–311. doi: 10.1016/s0009-9260(64)80002-7. [DOI] [PubMed] [Google Scholar]
  15. SIMON G., GALBRAITH H. J. Radiology of chronic bronchitis. Lancet. 1953 Oct 24;265(6791):850–852. doi: 10.1016/s0140-6736(53)90519-4. [DOI] [PubMed] [Google Scholar]
  16. SUTINEN S., CHRISTOFORIDIS A. J., KLUGH G. A., PRATT P. C. ROENTGENOLOGIC CRITERIA FOR THE RECOGNITION OF NONSYMPTOMATIC PULMONARY EMPHYSEMA. CORRELATION BETWEEN ROENTGENOLOGIC FINDINGS AND PULMONARY PATHOLOGY. Am Rev Respir Dis. 1965 Jan;91:69–76. doi: 10.1164/arrd.1965.91.1.69. [DOI] [PubMed] [Google Scholar]
  17. Woolcock A. J., Read J. Lung volumes in exacerbations of asthma. Am J Med. 1966 Aug;41(2):259–273. doi: 10.1016/0002-9343(66)90021-0. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES