CHEST RADIOGRAPHS IN ACUTE PULMONARY EMBOLISM
AbstractBackground: Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidityand mortality. Clinically, it is a difficult condition to diagnose and remains under treated conditionin Pakistan due to non-availability of objective tests and lack of awareness among physicians. Thisstudy was conducted to determine the chest radiographic presentation in known cases of acute PEpresenting to a tertiary care hospital. Methods: Hospital records of patients with a diagnosis ofacute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE onSpiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect wereselected. Two chest physicians reviewed the chest radiographs obtained during thathospitalization. In case of discrepancy, a radiologist made final interpretation. Results: The chestradiograph was interpreted as normal in only 18% of patients with acute PE. The most commonchest radiographic abnormalities were cardiac enlargement (38%), pulmonary parenchymalinfiltrates (34%), atelectasis (26%), pleural effusion (24%), and pulmonary congestion (24%).Other rare findings were elevated hemi diaphragm (14%), pulmonary artery enlargement (14%),and focal oligemia (8%). Conclusions: Cardiomegaly is the most common chest radiographicabnormality associated with acute pulmonary embolism. Chest radiography is not useful inmaking the diagnosis of acute pulmonary embolism. Its major role is in identification ofalternative disease processes that can mimic thrombo-embolismKeywords : Chest radiograph, Echocardiography, Pulmonary embolism
Value of the ventilation/perfusion scan in acute pulmonary
embolism. Results of the prospective investigation of
pulmonary embolism diagnosis (PIOPED). The PIOPED
Investigators.JAMA. 1990 May 23-30;263(20):2753-9.
Johnson MS. Current strategies for the diagnosis of
pulmonary embolus. J Vasc Interv Radiol. 2002;13(1):13-23.
Hogg K, Brown G, Dunning J, Wright J, Carley S, Foex B,
et al. Diagnosis of pulmonary embolism with CT pulmonary
angiography: a systematic review. Emerg Med J. 2006;
Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M,
Turpie AG, et al. Use of a clinical model for safe management
of patients with suspected pulmonary embolism. Ann Intern
Med. 1998;129(12): 997-1005.
Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA,
Thompson BT et al. Clinical, laboratory, roentgenographic,
and electrocardiographic findings in patients with acute
pulmonary embolism and no pre-existing cardiac or
pulmonary disease. Chest . 1991; 100(3): 598-603.
Anderson FA Jr, Wheeler HB. Venous thromboembolism.
Risk factors and prophylaxis.
Clin Chest Med. 1995 Jun;16(2):235-51..
Wharton LR, Pierson JW. Minor forms of pulmonary
embolism after abdominal operations. JAMA 1922;79: 1904-
Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan
RH, Ravin CE. Chest radiographic findings in patients with
acute pulmonary embolism: Observations from the PIOPED
Study. Radiology 1993;189(1):133-6.
Stein PD, Athanasoulis C, Greenspan RH, Henry JW.
Relation of plain chest radiographic findings to pulmonary
arterial pressure and arterial blood oxygen levels in patients
with acute pulmonary embolism. Am J Cardiol 1992; 69(4):
Usman MU, Bari V, Yaqoob J, Murad M. Diagnosis of
Pulmonary Embolism with helical C .T. Scan. J Pak Med
Assoc. 2003; 53(8): 354-56.
Schoepf UJ, Goldhaber SZ. Costello P. Spiral computed
tomography for acute pulmonary embolism. Circulation. 2004;
Elliott CG, Goldhaber SZ, Visani L, De Rosa M. Chest
radiographs in acute pulmonary embolism: Results from the
International Cooperative Pulmonary Embolism Registry.
Chest . 2000; 118(1): 33-8.
A Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary
embolism: clinical outcomes in the International Cooperative
Pulmonary Embolism Registry(ICOPER). Lancet . 1999;