Normal Chest X-Ray in Patients with Pulmonary Embolism May Involve Increased Risk of Massive Pulmonary Embolism


  •   Hatice Kilic

  •   Habibe Hezer

  •   Berker Ozturk

  •   Muhammed Sait Besler

  •   Huseyin Cetin

  •   Hatice Canan Hasanoglu

  •   Aysegul Karalezli


Purpose: Chest radiography is normal in approximately 20-40% of acute pulmonary embolism (PE) patients without cardiopulmonary disease. The aim of this study was to determine whether there is any difference between the patients with normal chest X-ray and those with pathological findings in terms of clinical severity and prognosis.

Methods: 178 of PE patients were included in the study. 110 patients had no parenchymal pathology, whereas group 1 (n = 110); group 2 (n = 68) had various pathological parenchymal findings in 68 patients. Clinical and radiological parameters were compared between these groups. Following the diagnosis of PE, the cases were recorded in the fifth year.

Results: In 178 participants; those with normal chest X-ray (group 1), with parenchymal pathological findings on the chest X-ray (group 2); echocardiographic systolic pulmonary artery pressure (sPAP) (p = 0.68), gender (p = 0.9) and thrombus type (p = 0.41) were similar.

The patients in group 1 were not different in terms of central thrombus detected in computed tomography pulmonary angiogram compared to the patients in group 2; however, the chest radiograph of the patients in group 1 had no parenchymal pathology. Central thrombus group 1, group 2, respectively; 97 (89.0%), 53 (77.9%), p = 0.07.

There was no significant difference between the two groups in terms of mortality which was followed up in fifth year (p > 0.05).

Conclusions: Normal chest X-ray in PE can determine mortality and may involve increased risk of massive PE.

Keywords: Central thrombosis, chest X-ray, computed tomography, pulmonary embolism


Chen S, Mulgrew B, Grant PM. A clustering technique for digital communications channel equalization using radial basis function networks. IEEE Trans. on Neural Networks. 1993; 4: 570-578.

Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman, HA, Thompson BT, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991; 100(3): 598-603.3.

Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology. 1993; 189(1): 133-136.

Powell T, Müller NL. Imaging of acute pulmonary thromboembolism: should spinal computed tomography replace the ventilation perfusion scan. Clin Chest Med. 2003; 24: 29-38.

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016; 149(2): 315-352.

Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). European Heart Journal. 2014; 35: 3033–73.

Abul Y, Ozsu S, Karakurt S, Ozben B, Durmus I, Toprak A, et al. Prediction of right ventricular dysfunction from radiographic estimates of right descending pulmonary artery in hemodynamically stable pulmonary embolism patients. Cardiology Journal. 2013; 20(2): 184-189.

Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real-World Registry). Journal of the American College of Cardiology. 2011; 57(6): 700-706.

Mos ICM, Klok FA, Kroft LJM, De Roos A, Dekkers OM, Huisman MV. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta‐analysis. Journal of Thrombosis and Haemostasis. 2009; 7(9): 1491-1498.

Carrier M, Righini M, Wells PS, Perrier A, Anderson DR, Rodger MA, et al. Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta‐analysis of the management outcome studies. Journal of Thrombosis and Haemostasis. 2010; 8(8): 1716-1722.

Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Vachiery JL. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). European Heart Journal. 2008; 29(18): 2276-2315.

Merten GJ, Burgess WP, Gray LV, Holleman JH, Roush TS, Kowalchuk GJ, et al. Prevention of contrast induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004; 291: 2328-34.

Johnson PT, Wechsler RJ, Salazar AM, Fisher AM, Nazarian LN, Steiner RM. Spiral CT of Acute Pulmonary Thromboembolism: Evaluation of Pleuroparenchymal Abnormalities Journal of Computer Assisted Tomography. 1999; 23(3): 369-373.

Shah AA, Davis SD, Gamsu G, Intriere L. Parenchymal and Pleural Findings in Patients with and Patients without Acute Pulmonary Embolism Detected at Spiral CT. Radiology. 1999; 211(1): 147-53.

Liu M, Cui A, Zhai ZG, Guo XJ, Li M, Teng LL, et al. Incidence of Pleural Effusion in Patients with Pulmonary Embolism. Chinese Medical Journal. 2015; 128: 1032-6.

Schumichen C. V/Q-scanning/SPECT for the diagnosis of pulmonary embolism. Respiration. 2003; 70: 329-342.

Bajc M, Neilly B, Miniati M, Mortensen J, Jonson B. Methodology for Ventilation/Perfusion SPECT. Seminars in Nuclear Medicine 2010; 40(6): 415-425.

Gouin B, Blondon M, Jimenez D, Fernandez-Capitan C, Bounameaux H, Soler S, et al. Clinical prognosis of nonmassive central and non-central pulmonary embolism: a register-based cohort study. Chest. 2016; 151(4): 829-837.


Download data is not yet available.


How to Cite
Kilic, H., Hezer, H., Ozturk, B., Besler, M. S., Cetin, H., Hasanoglu, H. C., & Karalezli, A. (2022). Normal Chest X-Ray in Patients with Pulmonary Embolism May Involve Increased Risk of Massive Pulmonary Embolism. European Journal of Medical and Health Sciences, 4(1), 1–4.