[The differential diagnosis of chronic bronchitis and emphysema from mutually supplemental functional and radiographic criteria]

Abstract

In a retrospective study in 91 patients an attempt was made to differentiate the primary and/or predominating disorder "emphysema" or/and "chronic bronchitis" by independent evaluation of a number of X-ray signs and lung function criteria in routine diagnosis. Good congruency of the diagnosis from these two different aspects, could be established. Patients with 3 or more X-ray signs of emphysema were found to have larger lung volume and smaller diffusing capacities than those without. Vice versa, patients with functional diagnosis of predominant emphysema more often showed the full X-ray pattern of emphysema, than those with predominant "chronic bronchitis". In either method of diagnostic procedure, the occurence of the "small heart of emphysema" was obviously much more frequent in patients believed to have predominant or primary emphysema. Assessment of X-ray signs of changes of the lesser circulation can be obtained in a stage of the disease, when structural changes have become irreversible. Considering the different pathophysiologic pattern of predominant panacinar emphysema, the destruction of alveolar walls and, consequently of the capillary bed, is more likely to reduce DCO as well as cardiac output before pulmonary hypertension can develop. The X-ray signs resulting from this effect on the lesser circulation, exist in widened right hilar branch and abrupt narrowing of peripheral vessels, with a small heart and lack of prominence of the pulmonary trunk. In chronic bronchitis, however, signs of pulmonary hypertension are expected to occur early in the disease. The relevance of the X-ray changes of the heart size and the pulmonary circulation in both types of lung disease, could be confirmed by lung function data.