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A 55-year-old female undergoes a hip replacement after a fall. Two days post op she develops sudden shortness of breath and tachycardia. On examination, she is tachypneic with a heart rate of 120. Her blood pressure is 120/57. Blood gas reveals a pH of 7.38, PCO2 35, PO2 72, and bicarbonate of 23. Duplex of the extremities reveals a large clot in the iliofemoral veins. What of the following is most likely to be found on a chest radiograph?
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Teaching Points
- The chest x-ray of a patient with pulmonary embolism is most often normal. This is the reason that this examination must be followed by CT pulmonary artery angiography and ventilation-perfusion scan.
- Westmark sign describes the relative area of oligemia or paucity of pulmonary markings on a chest x-ray due to vasoconstriction. It is seen in less than 10% of patients.
- Hampton hump describes wedge-shaped opacity which is pleural-based with convex medial border representing pulmonary infarction. Pleural effusion accompanies pulmonary infarction in acute and subacute phases. It may be absent in the hyperacute phase or when infarction is close to resolving.
- If the patient has a history of contrast allergy, a V/Q scan can be substituted.
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PubMed References
| [1] | Are We Overdiagnosing Pulmonary Embolism? "No"., Remy-Jardin M,, Journal of thoracic imaging, 2018 Sep 19 [PubMed PMID: 30239458] |
| [2] | The First Intrinsic Tenase Complex Inhibitor with Serine Protease Structure Offers a New Perspective in Anticoagulant Therapy., Latinović Z,Leonardi A,Kovačič L,Koh CY,Šribar J,Bakija AT,Venkateswarlu D,Kini RM,Križaj I,, Thrombosis and haemostasis, 2018 Sep 20 [PubMed PMID: 30235482] |
| [3] | Incidence and risk factors of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a systematic review and meta-analysis of cohort studies., Zhang M,Wang N,Zhai Z,Zhang M,Zhou R,Liu Y,Yang Y,, Journal of thoracic disease, 2018 Aug [PubMed PMID: 30233847] |
| [4] | Risk and prophylaxis of venous thromboembolism in hospitalized psychiatric patients. A review., Wilkowska A,Kujawska-Danecka H,Hajduk A,, Psychiatria polska, 2018 Jun 30 [PubMed PMID: 30218559] |
| [5] | A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy?, Burlacu A,Artene B,Covic A,, Cardiovascular drugs and therapy, 2018 Sep 5 [PubMed PMID: 30187347] |
