IMAGES IN EMERGENCY MEDICINE
Westermark’s sign in submassive pulmonary embolism
1 Academic Unit of Respiratory Medicine, Royal Free Hospital, London, UK
2 Department of Cardiology, Royal Free Hospital, London, UK
3 Department of Infectious Diseases, Royal Free Hospital, London, UK
Correspondence to:
Dr J R Hurst, Academic Unit of Respiratory Medicine, Royal Free and University College Medical School, Royal Free Hospital, London NW3 2PF, UK; j.hurst@medsch.ucl.ac.uk
Accepted 10 April 2008
| The first 150 words of the full text of this article appear below. |
A previously fit 72-year-old woman presented after an episode of syncope. She was alert but dyspnoeic, with a respiratory rate of 36 breaths per minute and an oxygen saturation of 81% breathing room air. Her pulse was 86 beats per minute and blood pressure was 110/60 mm Hg. Her chest was clear to auscultation.
A chest radiograph revealed a large radiolucent zone with a perihilar distribution, occupying the right upper and middle lung fields compatible with loss of the normal pulmonary vascular markings secondary to major proximal pulmonary embolism (Westermark’s sign;1 fig 1). An urgent computed tomography pulmonary angiogram demonstrated subtotal occlusion of the right main pulmonary artery thus corroborating the plain radiographic findings.
Figure 1 Anteroposterior chest radiograph showing a large radiolucent area in the right upper and middle zones where the normal pulmonary vascular markings have been lost due to major proximal pulmonary embolism (Westermark’s sign).
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Transthoracic echocardiography revealed
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