Can you see pulmonary emboli on a plain chest film?

EricJRN, MSN, RN · Oct 29, 2007

Not usually. There are a few signs on the CXR that can suggest PE.

http://www.emedicine.com/emerg/topic490.htm

lindarn · Oct 29, 2007

Title says it all, can you see pumlonary emboli on a plain font chest film? I Mean just the film, w/o running a D-dimer or anything else that would clue you in.
Jessica

The "gold standard" to diagnose PEs is a pulmonary angiogram. I don't think that you can see them on a standard CXR because they are in the pulmonary vasculature (which is why a pulmanary angiogram is done to diagnose a PE). Patient history and presenting symptoms would clue you in to a suspected diagnosis of pulmonary embolus.

Lindarn, RN, BSN, CCRN

Spokane, Washington

TooterIA · Oct 29, 2007

Wow, Ericenfermero, that link was AWESOME! I really learned a ton, thank you!

I will give you a little more background on my question, if you care. I had a 92 year old Pt come to the ER Fri night with hematochezia X 24 hours. We did a front chest film, Abd series, basic blood work, excluding D-Dimer-he showed no reason to. He was afebrile, denied pain, all vitals normal, lung sounds clear. He had a colonoscopy Sun morning and in recovery he developed uncontrolled A-fib, a new condition for him. He also bottomed his pressures as low as 60 systolic. They did a D-dimer which was positive, and sent him for a spiral CT, which is my small hospital's way of Dx PE's. He has mlutiple diffuse PE's. He is now on Dopamine, 15 L NRBM, uncontrolled A fib in the 150's and barely responsive. Anyway, I guess now I know more about PE's! Thanks!

Jessica

GmanRN · Oct 29, 2007

Usually suspected PEs are sent to CT to rule out.

ready4crna? · Oct 30, 2007

lindarn-

although a pulmonary angiogram would give you the info you need, I have to agree with the others here in that a spiral CT is about as definitive (good specificity/sensitivity profile). The spiral CT would also cost less and take less time with most modern scanners. Shorter diagnosis to treatment time= increased survival. Now, if your hospital has a gung-ho interventional radiologist that is sure he can get the bugger before knowing where it is, then go for the angiogram. Me, I'm a gittin mah CT.

jer_sd · Oct 30, 2007

I loved scrubbing in on diagnostic pulmonary angiograms normal ones are very cool to look at.... I have not done one in 3 years... CT scans have taken over much of this and also many VQ scans. We still do thrombolysis for saddlehorn PE once is a while. One quick clarification is the pulmonary embolism is not clot but a fractured central line or other solid embolism yes can be seen on cxr...

Zookeeper3 · Oct 30, 2007

We spiral CT anyone that has an acceptable creat. level. those that are on the brink of CRF or acute RF, we do pulmonary function tests which are much less diffinative. Our protocol does not allow thrombolytics to be given based upon a CXR.