We all know that CTA is the way to diagnose PE in a patient, but this requires a trip to CT and a large dose of IV contrast. So, there are ways to narrow things down in patients for whom PE is suspected. Most of us are familiar with evaluating right heart strain on bedside echo, and lots of us know that you can identify certain characteristic ECG changes. But, somewhat less well known is the radiographic sign known as Hampton’s Hump. This is a dome-shaped opacification that is most commonly associated with PE, but also can be a sign of pulmonary infarction due to other causes, such as angioinvasive aspergillosis. PE causes a wedge shaped infarct with sparing of the apex due to collateral circulation in the bronchial arteries. This leads to the characteristic rounded shape.
New England Journal of Medicine’s Images in Clinical Medicine series recently featured a nice example of this. This requires a free NEJM Online account to view the entire post (but the free account is well worth your time).
critical care notes 