Pulmonary embolism chest x ray
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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: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Chest X-Ray findings are common in both patients with and without PE, who do not have preexisting cardiovascular disease, thus limiting its diagnostic usefullness.
Chest X-Ray
- Chest X-rays are often done on patients with shortness of breath to help rule-out other causes, such as congestive heart failure and rib fracture. Chest X-rays in PE are rarely normal, but usually lack signs favoring confirmatory diagnosis of PE[1].
- Other, more ‘classic’ findings include
- Westermark sign (focal oligemia)
- Hampton hump (a peripheral wedge-shaped density above the diaphragm)
- Palla's sign (an enlarged right descending posteroanterior)
Prosective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study conducted by Stein et al came up with the following findings[2][3]:
- The most common chest x-ray (CXR) finding is atelectasis, seen in 69% of patient with PE and 58% patient without PE.
- Pleural effusion was found in 47% of patient with PE and 39% patient without PE.
- Only 12% of the CXRs in PIOPED were interpreted as normal
In an observational study, conducted at 52 hospitals in seven countries involving 2,454 patients, Cardiomegaly was the most common chest radiographic abnormality associated with acute pulmonary embolism; however cardiomegaly did not associate with echocardiographic findings of hypokinesia[4].
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.
- ↑ 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.
- ↑ Stein PD, Saltzman HA, Weg JG (1991). "Clinical characteristics of patients with acute pulmonary embolism". Am J Cardiol. 68 (17): 1723–4. PMID 1746481.
- ↑ 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.