MyPACS.net: Radiology Teaching Files > Case 8608533

previously visited HAMPTON'S HUMP(S) ON CXR CONFIRMED TO REPRESENT PE BY CHEST CT
Contributed by: Grant Lattin, Resident, David Grant Medical Center, Travis AFB, California, USA.
Patient: 50 year old male
History:

50 year old patient presents with shortness of breath

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Findings: Peripheral wedge shaped areas of consolidation abutting the pleural surfaces of the right lower lobe and lingual, respectively, on chest radiography.  CT demonstrates multiple pulmonary emboli with regions of lung consolidation in a similar distribution.
Diagnosis: Pulmonary emboli (PE)
Discussion: Pulmonary emboli (PE) originate from many sources but most are believed to originate as deep venous system thrombosis (DVT) of the lower extremities.  Virchow’s triad of stasis, injury of a vessel wall, and hypercoagulability, contribute to DVT formation.  Risk factors include such things as prolonged immobilization, pregnancy, preexisting hypercoagulable states, contraceptive use, and recent surgery, to name a few.  Patients will often present with dyspnea.  Classic radiographic signs associated with PE include Hampton’s hump (peripheral wedge shade region of consolidation which abuts the pleura), Westermark’s sign (regional oligemia secondary to an embolized vessel), and Fleischner’s sign (central pulmonary artery enlargement due to embolus).  Nonspecific findings may also include atelectasis and pleural effusion.  Imaging modalities may include chest radiograph followed by CT angiography or V/Q scan.  Ultrasound may also be used to evaluate for DVT in the lower extremities.  Pulmonary angiography is also available for diagnostic and/or therapeutic purposes.  Treatment generally involves systemic anticoagulation.  However, directed thrombolysis and IVC filter placement are other treatment options depending on the clinical scenario.
References:
  1. Goldhaber, SZ. Medical Progress: Pulmonary Embolism. New England Journal of Medicine, NEJM, 1998; 339:93-104.
  2. McCloud T. Thoracic Radiology: The Requisites. Mosby. St. Louis: MO, 1998.
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Additional Details:

Case Number: 8608533Last Updated: 04-02-2007
Anatomy: Chest   Pathology: Hematological
Modality: CT, Conventional RadiographAccess Level: Readable by all users
Keywords: pe, pulmonary embolism, hampton's hump

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