Pulmonary embolism chest x ray: Difference between revisions
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==Chest Radiography== | ==Chest Radiography== | ||
* Plain films of the chest are usually obtained for all patients with shortness of breath to evaluate for the various causes such as [[pneumonia]], [[congestive heart failure]], and [[rib fracture]]. Radiographic films of the chest in the setting of a PE are usually abnormal, but tend to lack any [[radiologic sign|signs]] that would confirm the diagnosis of a PE<ref>{{cite journal | author = Worsley D, Alavi A, Aronchick J, Chen J, Greenspan R, Ravin C | title = Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. | journal = Radiology | volume = 189 | issue = 1 | pages = 133-6 | year = 1993 | id = PMID 8372182}}</ref>. | * Plain films of the chest are usually obtained for all patients with shortness of breath to evaluate for the various causes such as [[pneumonia]], [[congestive heart failure]], and [[rib fracture]]. Radiographic films of the chest in the setting of a PE are usually abnormal, but tend to lack any [[radiologic sign|signs]] that would confirm the diagnosis of a PE<ref>{{cite journal | author = Worsley D, Alavi A, Aronchick J, Chen J, Greenspan R, Ravin C | title = Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. | journal = Radiology | volume = 189 | issue = 1 | pages = 133-6 | year = 1993 | id = PMID 8372182}}</ref>. | ||
* | * "Classic" findings include: | ||
*:*[[Westermark sign]] shows vasoconstriction distal to the pulmonary embolus. | *:*[[Westermark sign]] shows vasoconstriction distal to the pulmonary embolus. | ||
*:*[[Hampton hump]] shows a peripheral wedge-shaped density above the diaphragm. | *:*[[Hampton hump]] shows a peripheral wedge-shaped density above the diaphragm. | ||
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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
Radiographic abnormalities of the chest are commonly seen in both PE and non-PE patients in the absence of pre-existing cardiovascular disease, therefore its use in diagnosing a pulmonary embolism is limited.
Chest Radiography
- Plain films of the chest are usually obtained for all patients with shortness of breath to evaluate for the various causes such as pneumonia, congestive heart failure, and rib fracture. Radiographic films of the chest in the setting of a PE are usually abnormal, but tend to lack any signs that would confirm the diagnosis of a PE[1].
- "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 Propsective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study conducted by Stein et al illustrated the following results: [2][3]:
- The most common chest x-ray (CXR) abnormality found 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 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.