A chest X-ray of someone with suspected chronic obstructive pulmonary disease or COPD is a standard part of a diagnosis. The resulting image may reveal enlarged lungs, a flattened diaphragm, or potentially dangerous air pockets in the lungs called bullae.

COPD is a serious condition and is the third leading cause of death in the United States, according to the American Lung Association. A thorough diagnosis is crucial to begin treating COPD early, as it is an incurable condition.

People with COPD often experience initial signs, including:

  • coughing up a lot of mucus
  • shortness of breath
  • tightness in the chest

These signs often lead doctors to request X-ray images, to assess the stage of the disease. They may also order other tests to get a better understanding of how COPD is progressing in each case.

A thorough diagnosis helps doctors decide on the best treatment options.

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An X-ray can be confusing to the untrained eye, with shapes, shades, and other features all potentially indicating health issues.

Doctors can tell what is significant in the image and make a diagnosis or carry out further testing.

Also, chest X-rays allow doctors to assess the progression of COPD in a noninvasive way.

Before the X-ray, when first examining a person, a doctor will look for physical symptoms, including:

  • coughing or wheezing
  • production of a lot of mucus or sputum
  • difficulty breathing
  • continuous efforts to catch the breath
  • tightness in the chest

There are a few different preliminary steps to take before an X-ray for COPD:

Preparing for the X-ray

After setting an appointment with the doctor, a person will have to do nothing more until the day of the X-ray.

While performing the X-ray, the individual must remove their clothes above the waist and put on a hospital gown.

The X-ray itself usually takes place while the person is standing up. The technician will take one image from the front of the chest and one image from the side.

People may need to lie down in some cases, either because their symptoms make standing difficult or so the X-ray can produce a clearer image.

Lying down may be more likely in cases where doctors suspect there is extra fluid in the lungs. A doctor may ask the person to lie on their side and request additional images of the lungs in these cases.

The follow-up

Doctors will share their findings with the patient, using the X-ray images to explain what is happening inside their body.

There are visual indicators that may appear on an X-ray of someone with COPD.

Someone who is checking on the progression of their condition may be familiar with what their symptoms look like on an X-ray, but they may be surprising to someone who has only just had a diagnosis of COPD.


Chest X-rays of people with COPD may show signs of large lungs, known as hyperinflation.

Hyperinflation occurs when the lung tissue has been damaged and loses its elasticity. The lungs may also be trapping the air after each breath.

The result of this is that the person cannot make use of as much air with each breath as they otherwise would, which often leads to symptoms that include shortness of breath or difficulty breathing.

Flattened diaphragm

X-rays may also reveal structural changes in the lungs or surrounding tissue. The diaphragm may appear flattened in the chest, for example. This is also a result of hyperinflation, as the larger lungs push against the diaphragm, forcing it downward.

Changes in airways

Changes in the airways of the lungs are an early sign of COPD.

These changes can be difficult to accurately diagnose, as a study of the different imaging techniques posted to the Journal of Thoracic Disease notes.

Doctors take any potential changes they see in the airways as a sign to investigate further.


Doctors may also identify bullae on the X-ray.

Bullae are pockets of air that may develop when emphysema damages lung tissue. These pockets of air grow and can take away usable space in the lungs, which can make correct lung function difficult.

Doctors will usually plan to surgically remove bullae because they can be dangerous if left untreated.

Narrow heart

The heart may change shape as COPD progresses. An X-ray in people with emphysema may reveal a narrow or elongated-looking heart muscle.

This may be partly because of the heart changing how it sits in the chest to make room for the expanding lungs.

It may also happen because there is less volume in the left ventricle of the heart.

After examining an X-ray, doctors may request a computed tomography (CT) scan for a more comprehensive image to help in their diagnosis.

An X-ray is a flat image of the area, and a CT scan creates a 3-D image.

A CT scan is also more complex and provides more detail.

This allows doctors to check for issues, such as soft tissue damage, or to obtain a complete look of the organs without using invasive surgeries.

CT scans may also help doctors notice issues they might pick up much later on if relying solely on X-rays.

An X-ray or CT scan is just one step towards diagnosing COPD. Doctors will also need to test the function of the lungs and perform other tests.

After reviewing the images from the X-ray and the results of other tests, doctors will use signs of lung damage or chronic infection to make a COPD diagnosis.

Doctors will classify COPD into stages based on the progress of the symptoms that they see in the images and the result of the additional tests.

Chest X-rays are a useful tool to help diagnose COPD, but they are only one part of a diagnosis.

Chest X-rays expose the person to radiation, but they receive only a very small amount. Anyone who is pregnant should talk to their doctor before getting an X-ray, as they will need to take extra precautions.

It is important to follow up with treatment, as soon as possible, after a diagnosis. Many treatment options can help slow the progression of the disease and help manage symptoms for the best outlook.