Looking over Peer tutoring for the resp system…
“48 year old female with ovarian carcinoma presents to A+E with 12 hr history of haemoptysis. She also complains of dyspnoea and pleuritic chest pain. On examination she is apyrexial and has a right sided pleural rub. CXR shows a wedge shaped infarct peripherally on the right but is otherwise normal.”
So im thinking this is PE. My question is, in what cases would you see the ‘wedged shaped infarct’ Im guessing in most cases, this CXR sign is absent at PE presentation and thats part of the reason VQ scans etc are performed? Is the sign reliant on time of presentation ( i.e. length of time following infarct ) or also the size?
Thanks
Laura
Advertisement
Wedge shaped infarct is classical of PE, but it is rare. The wedge shape is due to the arterial supply of the lung fanning out in wedge shapes. Usually PEs are small, and do not produce the same degree of CXR change. Even large PEs can be associated with an entirely normal CXR. In massive PE, the CXR usually shows some degree of RV enlargement.
Other causes of a wedge of opacification – pneumonia, usually. Remember that white on a CXR is either fluid, collapse, or something solid.
So, a wedge is neither sensitive, nor specific for PE, but it is characteristic.
Thank you! : )