Pulmonary Embolism Chest X-ray Signs

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Pulmonary embolism (PE) refers to embolic occlusion of the pulmonary arterial system. The majority of cases result from thrombotic occlusion, and therefore the condition is frequently termed pulmonary thrombo-embolism.

 

Clinical Features:

  •  Dyspnoea, chest pain, and haemoptysis have been described as a classic triad in pulmonary embolism.

 

 

Markers for Pulmonary Embolism:

  • D-dimer (ELISA) is commonly used as a screening test.
  • normal D-dimer has almost 100% negative predictive value (virtually excludes PE)
  • Raised D-dimer is seen with PE but has many other causes and is, therefore, non-specific.

 

Chest X Ray

  • A chest x-ray is neither sensitive nor specific for a pulmonary embolism
  • It is used to rule out other causes of chest pain such as pneumonia or pneumothorax.

Chest X ray Signs in pulmonary Embolism

  1.  Fleischner lines:
  •        Long curvilinear densities reaching pleural surface
  •        enlarged pulmonary artery (20%)

flieshner's sign helpmedico

 

2. Hampton hump: peripheral wedge of airspace opacity and implies lung infarction (20%)

 

3. Westermark sign: is distension of pulmonary vasculature proximal to embolism with loss of vascular markings distally, i.e. localized peripheral oligemia (rare around 10%)

watermark sign-helpmedico

4. Palla sign: Enlarged right descending pulmonary artery

 

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5. Elevated hemidiaphragm

6. Chang sign :  dilated right descending pulmonary artery with sudden cut-off

7. Atelectasis or parenchymal abnormality (68%)

 

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Treatment of Pulmonary Embolism

  • cardiopulmonary support is the initial treatment.
  • Anticoagulation is provided in patients.
  • If the emboli are large or there is a large clot burden, thrombolysis can be done.
  •  embolectomy can also be done.

Hope this helps.

 

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