What are the ACR recommendations for the use of chest radiography in suspected pulmonary embolism (PE)?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

The ACR recommends chest radiography (see the images below) as the most appropriate study for ruling out other causes of chest pain in patients with suspected pulmonary embolism. [69] Initially, the chest radiographic findings are normal in most cases of pulmonary embolism. However, in later stages, radiographic signs may include a Westermark sign (dilatation of pulmonary vessels and a sharp cutoff), atelectasis, a small pleural effusion, and an elevated diaphragm. Generally, chest radiographs cannot be used to conclusively prove or exclude pulmonary embolism; however, radiography and electrocardiography may be useful for establishing alternative diagnoses. (See Electrocardiography.)

Posteroanterior and lateral chest radiograph findi Posteroanterior and lateral chest radiograph findings are normal, which is the usual finding in patients with pulmonary embolism.
A chest radiograph with normal findings in a 64-ye A chest radiograph with normal findings in a 64-year-old woman who presented with worsening breathlessness.
A posteroanterior chest radiograph showing a perip A posteroanterior chest radiograph showing a peripheral wedge-shaped infiltrate caused by pulmonary infarction secondary to pulmonary embolism. Hampton hump is a rare and nonspecific finding. Courtesy of Justin Wong, MD.

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