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
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
"Classic" findings include:
- Westermark sign shows vasoconstriction distal to the pulmonary embolus.
- Hampton hump shows a peripheral wedge-shaped density above the diaphragm.
- Palla's sign shows an enlarged right descending pulmonary artery.
The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study conducted by Stein et al illustrated the following results: [2][3]:
- The most common chest x-ray abnormality found is atelectasis, which was seen in 69% of patients with PE and 58% patient without PE.
- Pleural effusion was found in 47% of patients with PE and 39% of patients without PE.
- Only 12% of the chest x rays 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 was not associated with the 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.