Bottom line: Most prevalent findings include cardiac enlargement, normal, pleural effusion, elevated hemidiaphragm, pulmonary artery enlargement, atelectasis, and parenchymal pulmonary infiltrates. Individual findings are neither sensitive nor specific.
Multi-site prospective study of consecutive 2,454 patients from an international PE registry who received diagnosis of acute pulmonary embolism within 31 days of symptom onset. Chest x-rays available for 2,322 patients. Diagnosis of acute pulmonary embolism was confirmed by various imaging studies, including high-probability ventilation and perfusion scan, high-probability perfusion lung scan, pulmonary arteriogram, and echocardiogram. X-rays designated as abnormal were analyzed by investigators who identified presence/absence of these abnormalities. RESULTS: Most common findings were cardiac enlargement (27%), normal (24%), pleural effusion (23%), elevated hemidiaphragm (20%), pulmonary artery enlargement (19%), atelectasis (18%), and parenchymal pulmonary infiltrates (17%), pulmonary congestion (14%), pulmonary artery enlargement (Fleischner’s sign) (14%), focal oligemia (Westermark’s sign) (8%), peripheral wedge-shaped opacity over diaphragm (Hampton’s Hump) (5%), overinflation (5%).