What are the most common CXR findings in PE and their prevalence in PE patients?

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.

SummaryElliort CG, et al.  Chest radiograms in acute pulmonary embolism.  Chest.  2000; 118:33-38

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%).


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Clinical Informationist at EUH Branch Library
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