Chest radiography and CPOD A radiografia de tórax e a DPOC

Pulmonary emphysema and chronic bronchitis together are referred to under the acronym COPD. It is estimated that chronic obstructive pulmonary disease (COPD) affects approximately 6% to 15.8% of the population aged above 40 years, as the data obtained by the PLATINO study for São Paulo are generalized for the whole Brazilian population. Chronic obstructive pulmonary disease is the fifth leading cause of admission of patients above the age of 40 to the public health system in Brazil – 196,698 admissions into hospital per year, and expenditures of approximately 72 million Reais. The chronic inflmmatory process related to COPD may produce alterations affecting from bronchi (chronic bronquitis), bronchioles (obstructive bronchiolitis) to the lung parenchyma (pulmonary emphysema). Such anatomopathological alterations which are caused principally by smoking are found in varibale proportions among individuals affected by the disease, in correlation with clinical manifestations. Pulmonary emphysema (an injury that predominates in the lung parenchyma) and chronic bronchitis (injury affecting principally bronchi and bronchioles) represent the extreme manifestations of such alterations. The correlation between pathological anatomy and radiology in the investigation of enphysema is based on the concept that “excessive transparency at radiology results from an increased volume of air in relation to the amount of pulmonary tissues and blood which X-ray bemams encounter on its way”. The performance of plain radiography in the investigation of COPD is quite limited since in the absence of air trapping abnormalities cannot be detected on the image. In such cases, the main alteration corresponds to decreased vasculature which is only noticeable very belatedly in the natural course of disease, besides representing an extremely subjective criterion. In the presence of air trapping, the most reliable criteria include: 1. lowered or rectified diaphragm, below and anterior to the