Westermark’s sign & Palla’s sign of Pulmonary embolism on Chest Xray

A 68 year old female with atrial fibrillation and dementia presented to the hospital with sudden onset of dyspnea that had begun 1 hour earlier. Before admission, he had not been taking anticoagulation therapy on the basis of discussions of his preferences with his primary care physician. Physical examination was notable for tachypnea and tachycardia. On chest radiography, the pulmonary vasculature was not visible in the right lung fields. In addition, the right descending pulmonary artery was enlarged.

These radiograph findings display Westermark’s sign, which indicates an area of oligemia distal to a pulmonary embolism, and Palla’s sign, an enlargement of the right descending pulmonary artery. Computed tomographic (CT) pulmonary angiography of the chest confirmed the presence of pulmonary emboli in both pulmonary arteries, predominantly on the right side. The CT scan also showed oligemia in the lung parenchyma on the right side.

Source: NEJM

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