Plain Chest Roentgenogram in Patients with Acute Pulmonary Embolism and No Preexisting Cardiac or Pulmonary Disease

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Abstract
To determine the prevalence of chest radiographic signs and their relation to the clinical manifestations of acute pulmonary embolism among patients free of prior cardiac or pulmonary disease, we analyzed readings by trial radiologists of chest radiographs of 169 patients in the NHLBI Urokinase and Streptokinase Pulmonary Embolism Trials. The most prevalent radiographic signs were: an elevated hemidiaphragm (46%), consolidation (39%), pleural effusion (30%), atelectasis (28%), focal oligemia (22%) and proximal pulmonary artery distension (21%). One or more radiographic abnormalities were present in 76% of patients, with no difference in prevalence related to angiographic massivity of the pulmonary embolism. Conversely, radiographs showed no definite abnormality in 24% of patients. One or more signs suggestive of parenchymal involvement (elevated hemidiaphragm, consolidation, pleural fluid or atelectasis) were present in 67% (113/169). One or more vascular signs (pulmonary artery distention, focal oligemia or pulmonary arterial or venous hypertension patterns) were present in 37% (63/169). Parenchymal signs were more common in patients with the pulmonary infarction syndrome than in uncomplicated pulmonary embolism or in patients with vascular collapse. Vascular signs were more common among patients with angiographically massive pulmonary embolism than in patients with submassive pulmonary embolism, and there was a statistically insignificant trend for these signs to be more common among patients with circulatory collapse than in patients with pulmonary infarction or uncomplicated pulmonary embolism.

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