Pulmonary embolism chest x ray

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

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.
 * 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 :
 * 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.