Usefulness of electrocardiographic and radiographic changes in the diagnosis of acute pulmonary embolism

Abstract

### Learning Point for Clinicians The utility of electrocardiography (ECG) and chest radiography in the diagnosis of pulmonary embolism is often limited by their low sensitivity and specificity. However, the presence of multiple electrocardiographic signs of right ventricular (RV) overload and the Westermark sign (oligemia) in chest radiography suggests a high probability and severity of pulmonary embolism. A 75-year-old woman with a history of hypertension experienced general malaise and weakness for 1 day. Rapidly progressive shortness of breath was noticed thereafter and an ambulance was called by her family. On the way to the hospital, a sudden loss of consciousness was noted, and cardiopulmonary resuscitation was performed by emergency medical technicians for cardiac arrest. At emergency department arrival, cardiopulmonary resuscitation was continued, and spontaneous circulation was gained 12 min after onset of cardiopulmonary arrest. Physically, neither respiratory wheezes nor cardiac murmurs were heard. The post-resuscitation blood pressure was 122/96 mmHg, heart rate 118/min, body temperature 36°C and Glasgow coma scale E1M1V1. Vasopressor and …