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:
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.
- Findings on PE-related CXR changes have been evaluated among subjects enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) who have no cardiac and pulmonary diseases. The CXR findings were compared between 117 patients with PE vs 247 patients without PE. The most common CXR abnormality in PE was atelectasis. Shown below are the percentage of CXR findings among patients with PE vs those without PE: [2]
- Atelectasis: 68% vs 48%
- Pleural effusion: 48% vs 31%
- Elevated diaphragm: 24% vs 19%
- Cardiomegaly: 12% vs 11%
- Westermark's sign: 7% vs 2%
- Pulmonary edema: 4% vs 13%
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[3].
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.
- ↑ 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.