Chest 2000 Jul;118(1):33-8
Chest radiographs in acute pulmonary embolism. Results from the
International Cooperative Pulmonary Embolism Registry.
Elliott CG, Goldhaber SZ, Visani L, DeRosa M
OBJECTIVES: To characterize chest radiographic interpretations in a large population of
patients who have received a diagnosis of acute pulmonary embolism and to estimate the
sensitivity and specificity of chest radiographic abnormalities for right ventricular
hypokinesis that has been diagnosed by echocardiography. DESIGN: A prospective
observational study at 52 hospitals in seven countries. PATIENTS: A total of 2,454
consecutive patients who had received a diagnosis of acute pulmonary embolism between
January 1995 and November 1996. RESULTS: Chest radiographs were available for 2,322
patients (95%). The most common chest radiographic interpretations were cardiac
enlargement (27%), normal (24%), pleural effusion (23%), elevated hemidiaphragm (20%),
pulmonary artery enlargement (19%), atelectasis (18%), and parenchymal pulmonary
infiltrates (17%). The results of chest radiographs were abnormal for 509 of 655 patients
(78%) who had undergone a major surgical procedure within 2 months of the diagnosis of
pulmonary embolism: normal results for chest radiograph often accompanied pulmonary
embolism after genitourinary procedures (37%), orthopedic surgery (29%), or gynecologic
surgery (28%), whereas they rarely accompanied pulmonary emboli associated with thoracic
procedures (4%). Chest radiographs were interpreted to show cardiac enlargement for 149 of
309 patients with right ventricular hypokinesis that was detected by echocardiography
(sensitivity, 0.48) and for 178 of 485 patients without right ventricular hypokinesis
(specificity, 0.63). Chest radiographs were interpreted to show pulmonary artery
enlargement for 118 of 309 patients with right ventricular hypokinesis (sensitivity, 0.38)
and for 117 of 483 patients without right ventricular hypokinesis (specificity, 0.76).
CONCLUSIONS: Cardiomegaly is the most common chest radiographic abnormality associated
with acute pulmonary embolism. Neither pulmonary artery enlargement nor cardiomegaly
appears sensitive or specific for the echocardiographic finding of right ventricular
hypokinesis, an important predictor of mortality associated with acute pulmonary embolism.
PMID: 10893356, UI: 20353393
