Atelectasis/Pulmonary Edema

[zacarias, ASN, RN]

Hey all,

I'm a med/surg nurse with a question maybe one of you can answer. We had a patient with suspected pulmonary edema although he had no crackles. The portable chest X-ray showed subsegmental atelectasis. With increased O2 he did better and he got IV lasix also. The next day he had problems again and they did another CXR and the preliminary results showed pulmonary edema.

My question is, can subsegmental atelectasis be a very EARLY sign of pulmonary embolism?

Thanks.

[dianah, ASN]

I'm not sure if your question is about pulmonary edema or pulmonary embolism. I interpreted the question asking about the latter, embolism.

My Radiologist is unavailable at this time, I was just going to ask him! (Is there a Rad. in your area whom you may ask?)

I got this off the web, @ medceu, it's one of their tests. Very informative.

Imaging Studies:

The initial chest x-ray (CXR) findings of a patient with PE are virtually always normal.

On rare occasions they may show the Westermark sign, a dilatation of the pulmonary vessels proximal to an embolism along with collapse of distal vessels, sometimes with a sharp cutoff.

Over time, an initially normal CXR often begins to show atelectasis, which may progress to cause a small pleural effusion and an elevated hemidiaphragm.

After 24-72 hours, one third of patients with proven PE develop focal infiltrates that are indistinguishable from an infectious pneumonia.

A rare late finding of pulmonary infarction is the Hampton hump, a triangular or rounded pleural-based infiltrate with the apex pointed toward the hilum, frequently located adjacent to the diaphragm.

Will try to find more for you.

[dianah, ASN]

From http://medicine.ucsf.edu/housestaff/handbook/HospH2002_C4.htm

Work-up: Always think of PE in patients with new or unexplained dyspnea and/or hypoxemia. Studies should include:

- CXR: abnormal in 84% but non-specific: atelectasis, effusion, basilar opacity, elevated diaphragm, Westermark's sign (focal decreased pulmonary vessel perfusion), Hampton's hump (peripheral wedge shaped density).

Another good site specifically about pulmonary embolism:

http://emguidemaps.homestead.com/files/embolism.htm#Chest%20X-ray

Hope this helps. -- D

[zacarias, ASN, RN]

Dianah,

Thanks for the info!! I actually wrote it wrong, I was wondering if atelectasis can be a preliminary sign of pulmonary edema. Although I was also interested in pulmonary embolus since the patient I had is at VERY high risk (multiple clots throughout body).

Thanks for the information on the CXR findings. Yeah it seems that when people have PEs, their CXR is abnormal in some way.