Which radiographic feature is typical of COPD on chest imaging?

• A. Large mediastinal shift to the right
• B. Dense, lobular consolidation
• C. Hyperinflation with flattened diaphragms and increased retrosternal airspace
• D. Normal radiograph always

Answer: (C)

Air trapping from COPD leads to hyperinflation of the lungs, which is what chest imaging typically shows in this condition. On radiographs, the lungs appear overexpanded with diaphragms that are flattened rather than dome-shaped, and there is increased retrosternal airspace seen on the lateral view. These features reflect the loss of elastic recoil and air trapping seen in emphysema part of COPD. Dense lobular consolidation would point to infection or collapse rather than COPD. A large mediastinal shift is not characteristic of COPD and suggests another process such as pneumothorax or significant mediastinal pathology. While a mild or early COPD might occasionally appear normal, the classic, typical imaging finding is hyperinflation with flattened diaphragms and increased retrosternal airspace.