CTICasesAcute Pulmonary Embolism with Westmark Sign
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Imaging findings
A chest radiograph, when compared to a prior study, shows diminished vascularity and 'thread-like' vessels in the left lung, along with a noticeable difference in density between the two lungs. CTA confirms extensive central pulmonary emboli in both the right and left main pulmonary arteries, accompanied by right heart enlargement.
Key takeaways
The Westmark sign, characterized by regional oligohemia (diminished vascularity) on chest radiograph, is a rare but highly specific sign of acute pulmonary embolism. While historically considered sensitive and specific, it is uncommonly identified prospectively. This case demonstrates a clear example, observed as a difference in lung density on CT and reduced vascular caliber on coronal MIP reconstructions. Recognition, even in retrospect, can aid diagnosis.
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