Why not re-evaluate? The value of chest radiography

Clinical introduction A 67-year-old woman presented to the ED with a 1-week history of dyspnoea on exertion. She did not report fever or cough. Her medical history only included hyperlipidaemia. She was a never-smoker. Physical examination revealed the following findings: BP, 148/98 mm Hg; HR, 112/min; body temperature, 35.8℃; RR, 20/min; and oxygen saturation, 94% on ambient air. Lung sounds were clear; cardiac auscultation revealed a loud second heart sound. There was no leg oedema. Chest radiography was performed (figure 1). Question What is your diagnosis? Congestive heart failure Acute intestinal pneumonia Acute pulmonary embolism Pneumothorax Answer: C (Acute pulmonary embolism) Chest radiography showed the Fleischner sign (white arrow) and Westermark sign (black arrow) (figure 2) in the right upper lung field. The former, first reported by Fleischner in 1961, is dilatation of the proximal pulmonary artery...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research