COPD is characterized by hyperinflation. Other distinct signs are also present including flattened hemidiaphragms, widened costophrenic angles, and an elongated heart shadow. On the lateral view, there will be ab exaggerated retrosternal air space and a pronounced increase in AP diameter. The film may also appear hyperlucent due to the increased quantity of air in the lungs. In advanced hyperinflation , the intercostal spaces are noticeably widened.

Lung overdistension is more evident on the right side where the hemidiaphragm is in a low position and somewhat flattened. There is a widening of the intercostal spaces, the lung parenchyma is hyperlucent, and vascular markings are diminished in the periphery. Of additional interest is the lung pathology seen on the left pleural calcification is noted with blunting of the left costophrenic angle. These changes are most likely due to old pulmonary/ pleural tuberculosis.