Diagnosis of emphysema on chest radiographs

To evaluate how well pulmonary emphysema could be diagnosed on routine chest radiographs by using generally known criteria, a radio-pathologic correlative study was performed in 88 unselected patients with post-mortem verification of emphysema. The signs used were: I. Signs of overinflation as (a) blunting of the costophrenic sinuses and/or depression of the dome of the right diaphragm, (b) widening of the retrosternal airspace and (c) a right or obtuse sternodiaphragmatic angle, II. Irregular radiolucencies. III. Arterial deficiency. If two or more of the above signs were present, a total accuracy of 77% in detecting emphysema was achieved. The irregular radiolucency and arterial deficiency signs were sensitive but less accurate than those of overinflation.