What chest radiography findings suggest the presence of pulmonary embolism (PE)?

Updated: Oct 16, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Chest radiographs are abnormal in most cases of pulmonary embolism, but the findings are nonspecific. Common radiographic abnormalities include atelectasis, pleural effusion, parenchymal opacities, and elevation of a hemidiaphragm. The classic radiographic findings of pulmonary infarction include a wedge-shaped, pleura-based triangular opacity with an apex pointing toward the hilus (Hampton hump) or decreased vascularity (Westermark sign). These findings are suggestive of pulmonary embolism but are infrequently observed.

The abrupt tapering or cutoff of a pulmonary artery secondary to embolus (knuckle sign), cardiomegaly (especially on the right side of the heart), and pulmonary edema are other findings. In the appropriate clinical setting, these findings could be consistent with acute cor pulmonale. A normal-appearing chest radiograph in a patient with severe dyspnea and hypoxemia, but without evidence of bronchospasm or a cardiac shunt, is strongly suggestive of pulmonary embolism.


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