Which imaging finding is most consistent with advanced COPD?

• A. Clear lungs with no abnormalities
• B. Hyperinflation with flattened diaphragms
• C. Large pleural effusion
• D. Pneumothorax

Answer: (B)

Imaging in advanced COPD is dominated by air trapping and hyperinflation. Chronic emphysematous destruction of the lungs leads to increased lung volumes, a more horizontal and lower diaphragmatic silhouette, and increased retrosternal airspace on lateral views. These signs—hyperinflation with flattened diaphragms—are classic indicators of advanced COPD because they reflect the loss of elastic recoil and ongoing air trapping that characterize severe disease.

Other imaging patterns don’t fit COPD as well: a clear, normal-appearing chest would not reflect the structural lung changes seen in advanced disease; a large pleural effusion would cause blunting of the costophrenic angles with fluid levels; a pneumothorax would show a visceral pleural line with absent markings beyond it and potential collapse.