Generally, chest x ray is not recommended for chronic bronchitis diagnosis, but it is common to order it to rule out other causes of dyspnea and productive cough such as: pneumonia and heart failure. The common findings for chronic bronchitis includes: hyperinflation and hyperlucency of the lungs.

X-ray findings are not sensitive or specific for chronic bronchitis but it is helpful to look for diagnoses other than COPD that might cause the patient’s symptoms including: pneumonia, congestive heart failure, or even lung cancer. Common radiologic findings include^[1]:

• Radiolucency
• Diaphragmatic flattening due to hyperinflation
• Increased retrosternal airspace on the lateral radiograph

Note the flattened diaphragm and increased intercostal spaces due to hyperinflation.