Worsley D F, Alavi A, Aronchick J M, Chen J T, Greenspan R H, Ravin C E
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104.
Radiology. 1993 Oct;189(1):133-6. doi: 10.1148/radiology.189.1.8372182.
To determine the sensitivity, specificity, and positive and negative predictive values of chest radiographic findings in patients suspected of having acute pulmonary embolism (PE).
Chest radiographs of 1,063 patients with suspected PE were reviewed. PE was confirmed angiographically in 383 patients and excluded in 680 patients.
The chest radiograph was interpreted as normal in only 12% of patients with PE. 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. 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.
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.
确定胸部X线检查结果对疑似急性肺栓塞（PE）患者的敏感性、特异性、阳性预测值和阴性预测值。
回顾了1063例疑似PE患者的胸部X线片。383例患者经血管造影证实为PE，680例患者排除PE。
仅12%的PE患者胸部X线片显示正常。PE患者最常见的胸部X线表现是肺不张和/或实质区域密度增加；然而，其发生率与无PE患者相比无显著差异。寡血征（韦斯特马克征）、中央肺动脉突出（弗勒施纳征）胸膜下密度增加区域（汉普顿驼峰）、血管再分布、胸腔积液、膈肌抬高和肺门增大对PE的预测价值也较低。
虽然胸部X线片在疑似PE的检查中必不可少，但其主要价值在于排除临床疑似PE的诊断，并有助于通气-灌注扫描的解读。
