Chest X-ray in acute pulmonary embolism: forgiven but not forgotten

Excerpt

A 74-year-old woman was admitted in circulatory shock and acute respiratory failure. Standard 12-lead electrocardiogram showed sinus rhythms with an incomplete right bundle branch block. Chest X-ray revealed an area of focal oligemia in the right lower lung (Westermark’s sign) (Fig. 1, panel A, area between the two white triangles) and a significantly dilated right descending pulmonary artery with a “sausage-like” appearance (Palla’s sign), (Fig. 1, panel A, arrow). Subsequent emergent computed tomography angiography (CTA) demonstrated a large-sized pulmonary embolus (Fig. 1, panel B, arrow) into the right pulmonary artery, consistent with acute pulmonary embolism (PE). Catheter-direct treatment (CDT) was successfully performed. The concomitant existence of both Westermark’s and Palla’s has been rarely reported. However, their presence is helpful to suspect acute PE also in the CTA era.

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