The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema.

Abstract

The diagnosis of chronic pulmonary emphysema may be made with considerable accuracy in many instances. However, it is well recognized that this disease may exist without any clinical manifestations and that its clinical and physiologic manifestations in symptomatic patients are not unique but also occur in other pathologic conditions. The relative value of the chest film as an aid to the accurate diagnosis of emphysema has not been clearly defined. Most of the previous descriptions of the roentgenographic appearance of the chest and studies of the correlation between roentgenographic findings and diagnosis of emphysema have relied upon clinical or physiologic criteria or both for diagnosis. Utilizing clinical criteria, Kerley and associates (1) described the roentgenographic essentials as increased lung translucency, widened intercostal spaces, flattened depressed diaphragms, and widened costaphrenic angles. Parkinson and Hoyle (2) emphasized the frequent enlargement of the pulmonary conus and hilar pulmonary arteries as additional useful roentgenographic features. To the above signs, Lodge (3) added the findings of increased clarity and decreased diameter of second and third order intrapulmonary blood vessels. Whitfield and his associates ( 4) studied these characteristics in fifty-two patients judged to have moderate or severe emphysema on the basis of clinical and lung volume studies. They concluded that although chest films may provide evidence of emphysema, many of the previously described roentgenographic characteristics could be misleading. Knott and Christie (5) subjected the customarily accepted roentgenographic signs of emphysema to the test of blind roentgenographic interpretation by four