Pulmonary embolism chest x ray: Difference between revisions
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==Chest X Ray== | ==Chest X Ray== | ||
* | * According to a substudy of the Prospective Investigation of Pulmonary Embolism Diagnosis ('''PIOPED''') study on 1063 patients suspected to have PE, the most common CXR finding among patients with PE is [[atelectasis]] and/or increased opacity in parenchymal areas.<ref name="pmid8372182">{{cite journal| author=Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE| title=Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. | journal=Radiology | year= 1993 | volume= 189 | issue= 1 | pages= 133-6 | pmid=8372182 | doi=10.1148/radiology.189.1.8372182 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8372182 }} </ref> There was no significant difference between the prevalence of atelectasis and/or increased opacity in parenchymal areas among patients with confirmed PE vs those without PE.<ref name="pmid8372182">{{cite journal| author=Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE| title=Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. | journal=Radiology | year= 1993 | volume= 189 | issue= 1 | pages= 133-6 | pmid=8372182 | doi=10.1148/radiology.189.1.8372182 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8372182 }} </ref> | ||
* In contrast, in the observational retrospective study of The International Cooperative Pulmonary Embolism Registry (ICOPER) conducted at 52 hospitals in seven countries involving 2,454 patients, [[cardiomegaly]] was the most common chest radiographic abnormality associated with acute pulmonary embolism. Cardiomegaly was not associated with the echocardiographic findings of [[hypokinesia]].<ref name="pmid10893356">{{cite journal| author=Elliott CG, Goldhaber SZ, Visani L, DeRosa M| title=Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. | journal=Chest | year= 2000 | volume= 118 | issue= 1 | pages= 33-8 |pmid=10893356 | 5doi= | pmc= | url= }} </ref>. | |||
* Approximately 12%-24% of patients with PE have a normal CXR.<ref name="pmid8372182">{{cite journal| author=Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE| title=Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. | journal=Radiology | year= 1993 | volume= 189 | issue= 1 | pages= 133-6 | pmid=8372182 | doi=10.1148/radiology.189.1.8372182 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8372182 }} </ref><ref name="pmid10893356">{{cite journal| author=Elliott CG, Goldhaber SZ, Visani L, DeRosa M| title=Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. | journal=Chest | year= 2000 | volume= 118 | issue= 1 | pages= 33-8 | pmid=10893356 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10893356 }} </ref> | * Approximately 12%-24% of patients with PE have a normal CXR.<ref name="pmid8372182">{{cite journal| author=Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE| title=Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. | journal=Radiology | year= 1993 | volume= 189 | issue= 1 | pages= 133-6 | pmid=8372182 | doi=10.1148/radiology.189.1.8372182 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8372182 }} </ref><ref name="pmid10893356">{{cite journal| author=Elliott CG, Goldhaber SZ, Visani L, DeRosa M| title=Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. | journal=Chest | year= 2000 | volume= 118 | issue= 1 | pages= 33-8 | pmid=10893356 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10893356 }} </ref> | ||
* "Classic", yet less uncommon, findings include: | * "Classic", yet less uncommon, findings include: | ||
** [[Westermark sign]] | ** [[Westermark sign]]: vasoconstriction distal to the pulmonary [[embolus]] | ||
** [[Hampton hump]] | ** [[Hampton hump]]: peripheral wedge-shaped density above the [[diaphragm]] | ||
** [[Palla's sign]] | ** [[Palla's sign]]: enlarged right descending [[pulmonary artery]] | ||
* PE-related CXR changes have been evaluated among subjects free of cardiac and pulmonary diseases who were suspected to have PE and were enrolled in the PIOPED study. The CXR findings were compared between 117 patients with confirmed PE vs 247 patients without PE. The most common CXR abnormality in PE was [[atelectasis]] nd/or increased opacity in parenchymal areas. Shown below are the percentage of CXR findings among patients with PE vs those without PE:<ref name="pmid1909617">{{cite journal| author=Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT et al.| title=Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. | journal=Chest | year= 1991 | volume= 100 | issue= 3 | pages= 598-603 | pmid=1909617 | doi= | pmc= | url= }} </ref> | * PE-related CXR changes have been evaluated among subjects free of cardiac and pulmonary diseases who were suspected to have PE and were enrolled in the PIOPED study. The CXR findings were compared between 117 patients with confirmed PE vs 247 patients without PE. The most common CXR abnormality in PE was [[atelectasis]] nd/or increased opacity in parenchymal areas. Shown below are the percentage of CXR findings among patients with PE vs those without PE:<ref name="pmid1909617">{{cite journal| author=Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT et al.| title=Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. | journal=Chest | year= 1991 | volume= 100 | issue= 3 | pages= 598-603 | pmid=1909617 | doi= | pmc= | url= }} </ref> | ||
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** [[Westermark's sign]]: 7% vs 2% (p value is non significant) | ** [[Westermark's sign]]: 7% vs 2% (p value is non significant) | ||
** [[Pulmonary edema]]: 4% vs 13% (p <0.05) | ** [[Pulmonary edema]]: 4% vs 13% (p <0.05) | ||
==References== | ==References== | ||
Revision as of 15:06, 10 July 2014
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
A chest X ray is often obtained in patients with shortness of breath to diagnose pneumonia, congestive heart failure, and rib fracture. Although the chest X ray in the setting of a pulmonary embolism is often abnormal, the findings are non-specific and are not diagnostic of a pulmonary embolus.[1]
Chest X Ray
- According to a substudy of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study on 1063 patients suspected to have PE, the most common CXR finding among patients with PE is atelectasis and/or increased opacity in parenchymal areas.[2] There was no significant difference between the prevalence of atelectasis and/or increased opacity in parenchymal areas among patients with confirmed PE vs those without PE.[2]
- In contrast, in the observational retrospective study of The International Cooperative Pulmonary Embolism Registry (ICOPER) conducted at 52 hospitals in seven countries involving 2,454 patients, cardiomegaly was the most common chest radiographic abnormality associated with acute pulmonary embolism. Cardiomegaly was not associated with the echocardiographic findings of hypokinesia.[3].
- "Classic", yet less uncommon, findings include:
- Westermark sign: vasoconstriction distal to the pulmonary embolus
- Hampton hump: peripheral wedge-shaped density above the diaphragm
- Palla's sign: enlarged right descending pulmonary artery
- PE-related CXR changes have been evaluated among subjects free of cardiac and pulmonary diseases who were suspected to have PE and were enrolled in the PIOPED study. The CXR findings were compared between 117 patients with confirmed PE vs 247 patients without PE. The most common CXR abnormality in PE was atelectasis nd/or increased opacity in parenchymal areas. Shown below are the percentage of CXR findings among patients with PE vs those without PE:[4]
- Atelectasis and/or increased opacity in parenchymal areas: 68% vs 48% ( p <0.001)
- Pleural effusion: 48% vs 31% (p <0.01)
- Elevated diaphragm: 24% vs 19% (p value is non significant)
- Prominent central pulmonary artery (or Fleischner sign): 15% vs 11% (p value is non significant)
- Cardiomegaly: 12% vs 11% (p value is non significant)
- Westermark's sign: 7% vs 2% (p value is non significant)
- Pulmonary edema: 4% vs 13% (p <0.05)
References
- ↑ Worsley D, Alavi A, Aronchick J, Chen J, Greenspan R, Ravin C (1993). "Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study". Radiology. 189 (1): 133–6. PMID 8372182.
- ↑ 2.0 2.1 2.2 Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE (1993). "Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study". Radiology. 189 (1): 133–6. doi:10.1148/radiology.189.1.8372182. PMID 8372182.
- ↑ 3.0 3.1 Elliott CG, Goldhaber SZ, Visani L, DeRosa M (2000). "Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry". Chest. 118 (1): 33–8. PMID 10893356.
- ↑ Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT; et al. (1991). "Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease". Chest. 100 (3): 598–603. PMID 1909617.