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%). Westermark sign: ( west'er-mark ), in chest radiography, decreased lung markings from oligemia caused by pulmonary embolism. 2. En los rayos X de tórax se observaron calcificaciones intraparenquimatosas en ambos pulmones. Acta (2008) ISBN:0721629059. In-hospital bleeding complications occurred in 17.6% versus 9.7% and recurrent PE within 90 days in 12.6% and 7.6%, respectively (P<0.001). ### âEconomy class syndromeâ The most common chest radiographic finding in patients with PE was atelectasis and/or parenchymal areas of increased opacity; however, the prevalence was not significantly different from that in patients without PE. In this second review we discuss radiographic findings of cardiopulmonary disorders common in the intensive care patient and suggest guidelines for interpretation based not only on imaging but also on the pathophysiology and clinical grounds. None of the 11 patients who received an IVC filter developed recurrent PE within 90 days, and 10 (90.9%) survived at least 90 days. [Medline] . ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In chest radiography, the Westermark sign is a sign that represents a focus of oligemia (leading to collapse of vessel) seen distal to a pulmonary embolism (PE). Acute pulmonary embolism may occur rapidly and unpredictably and may be difficult to diagnose. We report a case of acute sub-massive PE treated with thrombolytic therapy in an elderly gentleman who had a paradoxical embolism and ischemic stroke as a result of a clot traversing through a PFO. The descending interlobar branch of the right pulmonary artery is enlarged, causing a "sausage" appearance towards … Right pulmonary artery is not dilated in post stenotic dilatation of pulmonary artery and idiopathic dilatation of pulmonary artery. ABSTRACT A 56-year-old man presented to the Accident In particular, the two proximal diameters of descending pulmonary artery were significantly enlarged (p less than 0.01). On examination, the patient was in respiratory distress and haemodynamic … Fleischner Sign 2.0 (1958). Chest X-Ray: * Decreased vascular markings beyond the clot (Westermark’s sign) * Wedge shaped opacity adjacent to the pleura, in case of infarction ( Hampton’s hump) * CXR is normal in many cases, but helps to see . Pulmonary vessels on CXR. Recognition of enlargement of the descending pulmonary artery may increase suspicion of pulmonary embolism; in particular, detection of "sausage" appearance of the vessel should identify patients with high probability of disease. © 2008-2021 ResearchGate GmbH. (2010) ISBN:1605479764. Thrombolytic therapy did not reduce 90-day mortality (thrombolysis, 46.3%; 95% CI, 31.0% to 64.8%; no thrombolysis, 55.1%; 95% CI, 44.3% to 66.7%; hazard ratio, 0.79; 95% CI, 0.44 to 1.43). Most thrombi are generated in the deep venous system of the lower leg and pelvis. 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). Results from the International Cooperative Pulmonary Embolism Registry, The normal roentgenographic measurement of the right descending pulmonary artery in 1085 cases, CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis1, Prevalence of Negative Chest Radiography Results in the Emergency Department Patient With Decompensated Heart Failure, Pulmonary embolism findings on chest radiographs and multislice spiral CT, [A study of chest X-ray findings of angio-immunoblastic lymphadenopathy (author's transl)], External Imaging of Pulmonary Perfusion and Ventilation. Lauren Westafer introduces the concept of a new generation of pulmonary embolism (PE). Bibliographies of pertinent articles also were scanned for suitable articles. The patient was diagnosed with pulmonary embolism (PE) and treated with heparin and edoxaban. Approximately 1 of every 5 patients admitted from the ED with acute decompensated heart failure had no signs of congestion on chest radiography. 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. Fleischner lectured and published extensively on pulmonary embolus and pulmonary hypertension between 1941 and 1962. Oligemia (the Westermark sign), prominent central pulmonary artery (the Fleischner sign), pleural-based area of increased opacity (the Hampton hump), vascular redistribution, pleural effusion, elevated diaphragm, and enlarged hilum were also poor predictors of PE. It is one of several described signs of pulmonary embolus on chest radiographs. In patients with massive PE, thrombolysis, surgical embolectomy, or catheter embolectomy were withheld in 73 (68%). Dr Gary Zhang Westermark sign Nils Johan Hugo Westermark (1892 - 1980) was a Swedish radiologist. Indeed, the chest X-ray will detect increased or reduced density of lung structures, thus providing information on lung anatomy, rather than function. In embolic patients, the vessel, measured at four different levels starting from the superior venous angle, was larger during acute embolization than some weeks later. Brenes-Salazar JA. Nurses' Health Study with 16 years of follow-up from 1976 to 1992. Based on self-report and medical records, we documented 280 cases of pulmonary embolism, of which 125 were primary (no identified antecedent cancer, trauma, surgery, or immobilization). The number of patients with subsegmental PE who had DVT was two (0.7% all patients). ... An area of focal oligemia due to embolic obstruction of a large pulmonary branch is known as Westermark’s sign. Recent studies have shown that the combination of a low pretest probability (using a clinical prediction rule) and a normal result of a D-dimer test reliably excludes pulmonary embolism without the need for further testing. In the emergency setting, thoracic imaging by standard chest X-ray (CXR) plays a crucial role in the diagnostic process, because it is of fast execution and relatively not expensive. Study methods were appraised independently by two researchers, and data were extracted independently by three researchers. Westermark sign (1938) Westermark sign describes chest x-ray findings in pulmonary embolism of a clarified area distal to a large vessel that is occluded by an embolus. In patients with discordant findings of clinical assessment and CT angiograms or CT angiogram/CT venogram, further evaluation may be necessary. Percutaneous needle biopsy revealed it to be a sclerosing haemangioma which was subsequently removed by a left lower lobectomy. Causes of dyspnoea are various and involve not only cardiovascular and respiratory systems. However, it is unclear whether recently developed clinical prediction rules, using explicit features of clinical examination, are comparable with clinicians' gestalt. patient was started on heparin injection with significant Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians. Westermark sign (1938) of relative oligemia on CXR in pulmonary embolism Gary Zhang; March 15, 2020; CXR eponyms in pulmonary embolism . Diagnostic studies give conflicting results for the diagnostic accuracy of CT pulmonary angiography. Chest radiography showed a Westermark sign . The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. Studies varied in prevalence of pulmonary embolism (19-79%), patient groups, and method quality. Does This Patient Have Pulmonary Embolism? The clinical gestalt of experienced clinicians and the clinical prediction rules used by physicians of varying experience have shown similar accuracy in discriminating among patients who have a low, moderate, or high pretest probability of pulmonary embolism. Chest X-ray and computed tomography showed a tumor in the left lung field. Other CT pulmonary angiographic findings in chronic pulmonary embolism include evidence of recanalization, webs or flaps, and partial filling defects that form obtuse angles with the vessel wall. We discussed diagnostic modalities, treatment of choice, and associated controversies in management. The CXR is also helpful in identifying or excluding other conditions or diagnoses. The focal area of increased translucency (oligaemia), occurs due to impaired vascularisation of the lung from primary mechanical obstruction or reflex vasoconstriction. Introduction. Experienced clinicians' gestalt is useful in estimating the pretest probability for pulmonary embolism and is complementary to diagnostic testing, such as lung scanning. Postgrad Med 2014; 90: 420-421. PE was confirmed angiographically in 383 patients and excluded in 680 patients. The proportion of patients with an ED non-heart failure admitting diagnosis was higher in patients with a negative chest radiograph result (23.3%; 95% CI 22.6% to 23.9%) than in patients with a positive chest radiograph result (13.0%; 95% CI 12.7% to 13.2%). Westermark sign is a focal peripheral hyperlucency secondary to oligemia, and is a sign of pulmonary embolus on … Moreover, the sensitivity of CXR is much impaired when the study is performed at bedside by portable machines, particularly in the diagnosis of some important causes of acute dyspnoea, such as pulmonary embolism, pneumothorax, and pulmonary edema. had positive finding on chest X ray. This study determines the rate of negative chest radiography results in patients found to have disease and the potential contribution of negative findings to a diagnosis discordant with heart failure by an emergency physician. Diagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies. The diagnostic quality of CTPA was insufficient in 5.9%, acceptable in 8.2%, and excellent in 85.9% of the patients. 1, 64-MDCT Pulmonary Angiography and CT Venography in the Diagnosis of Thromboembolic Disease, Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study, A prospective study of risk factors in pulmonary embolism in women, Chest Radiographs in acute pulmonary embolism. Observers assessed the chest radiographic abnormalities and classified the chest radiograph as normal or abnormal. Thoracic Imaging. This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital. Roughly ten percent of pulmonary embolisms result in pulmonary infarction, but many patients die of PE without being diagnosed. Hampton hump refers to a dome-shaped, pleural-based opacification in the lung most commonly due to pulmonary embolism and lung infarction (it can also result from other causes of pulmonary infarction (e.g. Pulmonary Embolism. The importance of this causal link is under debate as most travellers who develop venous thromboembolism have additional risk factors.8 A 2001 study of 135.29 million passengers showed an incidence of pulmonary embolism of 1.5 cases per million for travel over 5000 km, compared with 0.01 cases per â¦. Chest radiographs were reviewed for changes in the right descending pulmonary artery in 73 patients with confirmed pulmonary embolism and in 85 in whom the original suspicion subsequently was not confirmed. air travel ten days earlier. If so, clinical prediction rules would be powerful tools because they could be used by less-experienced health care professionals to simplify the diagnosis of pulmonary embolism. In literature many studies have demonstrated how important and essential is an accurate direct interpretation by the clinician without the need of an immediate reading by the radiologist. 3. Of all patients, 3.9% (12 of 306) had only isolated DVT. Three reviewers independently scanned titles and abstracts for inclusion of studies. The pooled false negative rate of combined negative CT pulmonary angiography and negative deep vein thrombosis testing was 1.5% (95% CI 1.0 to 1.9%). Radiol 1938;19:357â72. Unable to process the form. Dyspnoea, defined as an uncomfortable awareness of breathing, together with thoracic pain are two of the most frequent symptoms of presentation of thoracic diseases in the Emergency Department (ED). Among 2392 patients with acute PE and known systolic arterial blood pressure at presentation, from the International Cooperative Pulmonary Embolism Registry (ICOPER), 108 (4.5%) had massive PE, defined as a systolic arterial pressure <90 mm Hg, and 2284 (95.5%) had non-massive PE with a systolic arterial pressure > or =90 mm Hg. To be included in the analysis, studies were required to have consecutive, unselected patients enrolled; participating physicians in the studies, blinded to the results of diagnostic testing, had to estimate pretest probability of pulmonary embolism; and validated diagnostic methods had to be used to confirm or exclude pulmonary embolism. the historical radiographic signs and the current dualenergy Observation of the radiologic changes in pulmonary Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Transbronchial biopsy was performed and the final diagnosis was alveolar pulmonary microlithiasis. Westermark's and Palla's signs in acute pulmonary embolism, Chest radiographs in acute pulmonary embolism, Clinical policy: Critical issues in the evaluation and management of adult patients presenting with suspected lower-extremity deep venous thrombosis. of lungs + some other investigations. 2014; 7(1): 57-58. Chest X-ray exam showed intraparenchimatous calcification in the lungs. This enlargement of the superior part was responsible for the shape modification of the vessel, which appeared to taper off sharply. The level of interobserver agreement for the interpretation of the chest radiograph as consistent or not with PE was fair (k = 0.24; 95% CI: 0.19-0.29), regardless of the observer experience. Thus X-Ray Control of these risk factors will decrease risks of pulmonary embolism as well as coronary heart disease. This finding is uncommon in patients with PE but has high specificity, Subtle CXR signs of PE: The pala's and Westermark signs. Acute massive pulmonary embolism (PE) carries an exceptionally high mortality rate. Its major role is in identification of alternative disease processes that can mimic thrombo-embolism. The study group was classified according to the diagnostic quality of the CTPA examinations, the presence or absence of PE and deep venous thrombosis (DVT), and the most proximal localization that the embolus could lodge in the pulmonary artery. Se le realizó biopsia transbronquial y el diagnóstico definitivo fue una microlitiasis alveolar pulmonar. The chest radiograph was interpreted as normal in only 12% of patients with PE. We used data from the Acute Decompensated Heart Failure National Registry (ADHERE), a registry of patients with a primary hospital discharge diagnosis of heart failure. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Although chest radiographs are essential in the investigation of suspected PE, their main value is to exclude diagnoses that clinically mimic PE and to aid in the interpretation of the ventilation-perfusion scan. Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis, la literaturaWe presented the case of a 32 years-old black male patient that was seen at the doctor's because he had hemoptoic expectoration that occasionally contains microlites. Revisiting signs, strengths and weaknesses of Standard Chest Radiography in patients of Acute Dyspnea in the Emergency Department, Pulmonary embolism in patients with chronic hypoxemia, Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient, Enlargement of the right descending pulmonary artery in pulmonary embolism. Bosco JIE, Khoo RN, Peh WC. of sudden onset. Acknowledgement: Dr Simon … It is named after Aubrey Otis Hampton, who first described it in 1940. The theory behind the sign is either obstruction of the pulmonary artery or distal vasoconstriction in hypoxic lung 3. The proportion of patients with a non-heart failure ED diagnosis and the diagnostic sensitivity of radiographic findings of heart failure are calculated. Palla sign describes an enlarged right descending pulmonary artery.When present with the Westermark sign, is suggestive of an occlusion of a lobar or segmental pulmonary artery, or widespread occlusion of small arteries.. Radiographic features Plain radiograph. Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. CONCLUSION: 90% of the patients had positive x-ray finding. computed tomography innovations. Fleischer FG. Source Signs in Thoracic Imaging Journal of Thoracic Imaging 21(1):76-90, March 2006. Follow up scans are needed during long treatment procedure which BACKGROUND: Idiopathic Pulmonary Fibrosis is a chronic pulmonary disorder characterized by thickening of The Brant and Helms Solution. E.Brant MW, A.Helms MC. 5. The sign results from a combination of: the dilation of the pulmonary arteries proximal to the embolus and In about one-fourth of the patients with pulmonary embolism, enlargement and shape modification were so marked that the artery showed a special "sausage" appearance. Material and methods. 2002 Mar. Clinicians should not rule out heart failure in patients with no radiographic signs of congestion. Westermark was also an accomplished sailor and won a silver medal, as a member of the Swedish team, at the 1912 Olympics in Stockholm 7. Se presentó el caso de un pacientes de 32 años de edad, raza negra y sexo masculino que consultó por expectoración hemoptoica que, en ocasiones, contenÃa microlitos. While the chest x-ray is normal in the majority of PE cases, the Westermark sign is seen in 2% of patients. Pathology. 121(3):877-905. (2010), differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. AMIRSYS. Pregnancy-adapted YEARS algorithm provides high certainty in ruling out pulmonary embolism and high efficiency in reducing the need for CTPA http://bit.ly/2GgH4sv. Pulmonary embolism (PE) is not uncommon in the inpatient setting. Lippincott Williams &Wilkins. Westermark Sign in Pulmonary Embolism List of authors. of pulmonary embolism are described, with emphasis on Chest radiographs were available for 2,322 patients (95%). The percentages of nondiagnostic examinations for CTPA and CTV were 5.2% and 10.8%, respectively. Chest X-Ray Based Tumor Growth Assessment for Lung Tumor Diagnosis. Chest radiography is not useful in making the diagnosis of acute pulmonary embolism. & METH ODS: X-rays of 30 diagnosed peripheral-based opacity in the right lower zone, which Hamptom's Hump. To investigate risk factors for pulmonary embolism in women. Risk stratification and appropriate consideration of diagnostic strategies alternative to pulmonary CT angiography, as the first-line and stand-alone technique, should guide clinical decision making in patients who are suspected of having pulmonary embolism. CTPA-proven pulmonary embolus (not shown). Specifically, obese women (body mass index > or = 29.0 kg/m2) had an increased risk of primary pulmonary embolism (multivariate relative risk=2.9; 95% confidence interval [CI], 1.5-5.4). {"url":"/signup-modal-props.json?lang=us\u0026email="}. Abrupt cut off is seen in pulmonary embolism (knuckle sign). On the Roentgen Diagnosis of Lung Embolism, Interobserver Reliability of the Chest Radiograph in Pulmonary Embolism, Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association, Pulmonary CT Angiography in Patients Suspected of Having Pulmonary Embolism: Case Finding or Screening Procedure? To read the full-text of this research, you can request a copy directly from the authors. Westermark sign is a sign of pulmonary embolus seen on chest radiographs. Up to 50% of leg thrombi embolise; clots above the knee do so more commonly than clots below the knee.4 w3 Large clots may lodge at the bifurcation of the main pulmonary arteries, causing haemodynamic compromise. The most common chest radiographic abnormalities were cardiac enlargement (38%), pulmonary parenchymal infiltrates (34%), atelectasis (26%), pleural effusion (24%), and pulmonary congestion (24%). ... Rajendran R, Singh B, Bhat P. Subtle CXR signs of PE: The pala's and Westermark … RESULTS: Out of 30 patients 27/30 (90%) The primary source is thrombus from the deep veins of the legs. Recurrent PE rates at 90 days were similar in patients with and without thrombolytic therapy (12% for both; P=0.99). Lippincott Williams & Wilkins. Westermark N. On the roentgen diagnosis of lung embolism. Westermark sign is a chest x-ray finding of oligaemia (clarified area) distal to a large vessel that is occluded by a pulmonary embolus. Images in cardiovascular medicine. 7. raised. A pulmonary embolism is an obstruction of part of the pulmonary vascular tree, usually caused by a thrombus that has travelled from a distant siteâfor example, the deep veins in the leg. Frontal radiograph (A) and an enhanced CT of the chest (B) demonstrate lucency within the right upper lobe representing oligemia secondary to pulmonary embolism. Patients lacking signs of congestion on ED chest radiography were more likely to have an ED non-heart failure diagnosis than patients with signs of congestion. Despite the publication of evidence-based clinical practice guidelines to aid in the management of VTE in its acute and chronic forms, the clinician is frequently confronted with manifestations of VTE for which data are sparse and optimal management is unclear. Factors that cause misdiagnosis of pulmonary embolism may be patient related, technical, anatomic, or pathologic. Thirteen diagnostic and 11 follow up studies were identified. Radiographic feature of PE: confirmed the diagnosis of pulmonary embolism in The focal area of increased translucency due to oligaemia is caused by impaired vascularisation of the lung due to primary … Paradoxical embolism in the presence of a patent foramen ovale (PFO) is a rare but well-known entity and should always be looked for in case of a PE associated with systemic thromboembolism. Westermark sign (1938) of relative oligemia on CXR in pulmonary embolism WEstermark's and Palla's signs in acute and collapsed lung, consistent with lung infarction. This feature did not occur in patients with unconfirmed suspicion of pulmonary embolism. Westermark sign is a sign of pulmonary embolus seen on chest radiographs. We advocate the use of a clinical prediction rule because it has shown to be accurate and can be used by less-experienced clinicians. Roentgenologically, in addition to the classical infarct, we look … Pulmonary embolism has an untreated mortality of about 30% and is the commonest cause of death after elective surgery (accounting for up to 15% of all post-operative deaths).2 w2 It is the commonest cause of maternal death in the United Kingdom.3 Palla sign: Enlarged right descending pulmonary artery Acute PE and acute DVT were observed in 25.2% and 18.0%, respectively. Overall, there were 15,937 patients with no signs of congestion on ED chest radiography, giving a negative rate of 18.7% (95% confidence interval [CI] 18.4% to 18.9%). THE VALUE OF CHEST X RAY IN FOLLOW-UP THE PATIENTS WITH CARDIAC DYSFUNCTION, Chest X-ray in acute pulmonary embolism: forgiven but not forgotten. Clinics in diagnostic imaging : Right lower lobe segmental pulmonary embolus. Venous thromboembolism (VTE) is responsible for the hospitalization of >250 000 Americans annually and represents a significant risk for morbidity and mortality. The sequence for diagnostic test in patients with suspected pulmonary embolism depends on the clinical circumstances. Hampton's hump, also called Hampton hump, is a radiologic sign which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface. Heavy cigarette smokers also had an increased risk of primary pulmonary embolism. The purpose of our study was to investigate whether CT venography (CTV) performed after CT pulmonary angiography (CTPA) using 64-MDCT provides additional findings in the diagnosis of thromboembolic disease. Journal of thoracic imaging. Pulmonary embolism often is undetected during life, even though adequate diagnostic procedures are available, probably because the condition is not suspected. Radiographic feature of PE: Hamptom's Hump. Three hundred six consecutive patients in whom pulmonary embolism (PE) was clinically suspected were included in the study. The MEDLINE database was searched for relevant articles published between 1966 and March 2003. 2007;115 (8): e211. Pulmonary embolism (PE) is the obstruction of one or more pulmonary arteries by solid, liquid, or gaseous masses. The clinical and imaging features There were 85,376 patients with chest radiograph results and an ED admitting diagnosis. Information on height, weight, cigarette smoking, hypertension, diabetes, and hypercholesterolemia was collected by questionnaire. This study are realised in the order to answer the question: How well the chest X ray reflect the cardiac dysfunction? Osborn A, Blaser S, Salzman K. Encyclopedia of Diagnostic Imaging. âEconomy class syndromeâ is thromboembolic disease associated with long distance sedentary travel; the incidence of venous thromboembolic disease increases with distance travelled. This study was sought to evaluate the interobserver agreement for interpreting the chest radiograph of patients with suspected acute pulmonary embolism (PE). Results and conclusion. The chest X ray in pulmonary embolism: Westermark sign, Hampton's Hump and Palla's sign. The PIOPED II investigators recommend stratification of all patients with suspected pulmonary embolism according to an objective clinical probability assessment. The D-dimer level was We compared initial ED admitting diagnosis to the criterion standard of a hospital discharge diagnosis of heart failure and related these to radiographic findings of heart failure (interstitial edema, pulmonary edema, or vascular congestion, as determined by a staff radiologist) for patients first treated in the ED. Any study which compared CT pulmonary angiography to an acceptable reference standard or prospectively followed up a cohort of patients with a normal CT pulmonary angiogram was included. 1. The percentage of subsegmental emboli among patients with acute PE was 15.6%. Westermark signs. Material and methods: An asymptomatic middle-aged women was investigated for a lung nodule detected on routine chest X-ray. Circulation. In this case, the Westermark sign is evident in the right upper lung zones. We explored how often adjunctive therapies, particularly thrombolysis and inferior vena caval (IVC) filter placement, were performed and how these therapies affected the clinical outcome of patients with massive PE. Can prevent further Imaging tests Johan Hugo Westermark ( 1892 - 1980 ) was a Swedish radiologist Johan. Y el diagnóstico definitivo fue una microlitiasis alveolar pulmonar X-ray exam showed intraparenchimatous calcification the! Into major and minor factors oligemia due to embolic obstruction of the with... Patent vessels ):76-90, March 2006 that CT pulmonary angiography for targeting patients with suspected pulmonary! 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