The 'wet Westermark' sign.
A 67-year-old woman experienced dyspnea and exertional intolerance after aortocoronary bypass grafting. Early in the postoperative course, she had mild heart failure due to volume overload. Regional oligemia was appreciated on the chest radiograph. The oligemia led to the consideration of pulmonary embolism and was corroborated by perfusion scanning, which demonstrated defects in the same areas. Interstitial markings, accentuated by the heart failure, served as a serendipitous form of radiographic 'contrast' - a marker of blood perfusion and, in the present case, regional underperfusion. Therefore, mild heart failure accentuates 'Westermark's' sign.
Hutchison
Stuart J
SJ
Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Canada. stuart.hutchison@utoronto.ca
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure; D006801:Humans; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography