CTICasesPulmonary Embolism with Westermark Sign
Imaging findings
An intubated ICU patient has a radiograph showing asymmetric lung density with the left lung more radiodense and the right more lucent, likely accentuated by end-expiration. CT shows a large pulmonary artery clot burden, predominantly right-sided but with left-sided emboli as well, and mild oligemia.
Key takeaways
Asymmetric lung lucency on a radiograph, once rotation and pleural fluid are excluded, can reflect the Westermark sign of regional oligemia from pulmonary embolism, sometimes accentuated by expiration in a patient who cannot follow breath-hold instructions. A large pulmonary artery clot burden confirms the diagnosis.
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