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肺栓塞胸片征象的经典命名法回顾

CXR eponyms in pulmonary embolism

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一句话结论肺栓塞的Westermark、Hampton、Fleischner、Chang和Palla征实际上描述同一疾病过程在不同血管和实质的表现，且在CTPA时代这些胸片征象诊断肺栓塞的独立预测价值很差。

经典肺栓塞胸片征象包括近端肺动脉扩张（Fleischner征）、远端血管缺失（Westermark征）、外周肺梗死（Hampton hump）和继发性盘状肺不张（Fleischner线）。这些征象并非孤立诊断标志，而是描述肺动脉阻塞、急性肺动脉高压、区域性少血和出血性梗死等同一病理过程的不同表现。PIOPED研究显示Westermark征、Fleischner征和Hampton hump均为肺栓塞的差独立预测因子。在CTPA时代，胸片主要用于识别替代诊断和偶发线索，而非直接诊断或排除肺栓塞。

要点

PIOPED研究中383例血管造影确诊肺栓塞和680例排除肺栓塞的患者分析显示，Westermark征、Fleischner征（中央肺动脉突出）和Hampton hump均为肺栓塞的差独立预测因子。
Greenspan等1982年研究将152例疑似肺栓塞患者的胸片随机分配给9名盲法阅片者，证明胸片诊断肺栓塞的总体准确性差，且阅片者经验与诊断表现无明显关系。
Westermark征的原始定义是远端血管缺失导致的区域性血管稀疏，而非单纯透亮度增加；Hampton hump原始描述为圆形、半球形或截锥形病灶，「驼峰」指其向内凸的边缘，并非简单的楔形阴影。
Chang征指降肺动脉口径的短暂性扩张（右侧17-22 mm，左侧17-26 mm，23例肺梗死患者全部出现），而非血管截断；Palla征指右降肺动脉近端扩张伴远端突然变细呈「香肠」样畸形。
国际肺栓塞协作注册研究(ICPOER)2322例胸片患者中，肺动脉扩张报告率为19%，低于心脏扩大的27%。

适用人群与场景

原文回顾了1910-2000年间疑似或确诊肺栓塞患者的胸片研究，包括尸检证实、血管造影确诊和临床随访病例。
PIOPED研究纳入1063例疑似肺栓塞患者，其中383例血管造影确诊肺栓塞，680例排除肺栓塞。
Greenspan等1982年研究纳入152例疑似肺栓塞患者。
Chang和Davis 1965年研究纳入23例连续肺梗死患者，其中19例右侧梗死，4例左侧梗死。
Palla等1983年研究回顾性分析374例连续疑似肺栓塞入院患者。

诊断标准与关键阈值

Westermark征：远端栓塞性动脉阻塞导致的区域性肺少血，表现为外周血管标志减少或消失，中央血管仍可见但可能在少血区边缘突然终止。
Hampton hump：外周胸膜基底部出血性梗死，特征为向内（心脏侧）凸的边缘，形态可为圆形、半球形或截锥形。
Fleischner征：近端或中央肺动脉突出、扩张，与阻塞和急性肺动脉高压相关。
Chang征：既往正常的右或左降肺动脉出现新的口径扩张，可能可逆；右侧17-22 mm，左侧17-26 mm（23例肺梗死患者数据）。
Palla征：右降肺动脉近端扩张伴远端突然变细，产生特征性「香肠」样形态。
Fleischner线：盘状肺不张，为间接且非特异性表现。
Chang 1962年建立了正常右降肺动脉的胸片测量参考值，基于1085例患者。

处置流程与药物剂量

原文未提及

红旗征与不能漏的情况

原文未提及

研究设计与关键结果

本文为综述，回顾了肺栓塞经典胸片征象的历史发展（1910-2000年）及其在CTPA时代的意义。
PIOPED研究（Worsley等1993）回顾1063例疑似肺栓塞患者胸片，383例血管造影确诊肺栓塞，680例排除肺栓塞，发现少血（Westermark征）、中央肺动脉突出（Fleischner征）和胸膜基底部阴影（Hampton hump）均为肺栓塞的差独立预测因子。
Greenspan等1982年前瞻性研究将152例疑似肺栓塞患者的胸片随机分配给9名盲法阅片者，证明胸片诊断肺栓塞的总体准确性差，阅片者经验与诊断表现无明显关系。
Chang和Davis 1965年研究23例连续肺梗死患者，发现全部病例均有降肺动脉扩张：19例右侧梗死为17-22 mm，4例左侧梗死为17-26 mm。
Palla等1983年研究374例连续疑似肺栓塞患者，定量比较确诊与未确诊肺栓塞患者的右降肺动脉直径，描述急性肺栓塞时近端右降肺动脉可扩张、密度增高、显著，伴远端相对突然变细。
Fleischner 1958年研究显示肺动脉直径可动态变化，例如系列测量为11→14→22→15 mm。
国际肺栓塞协作注册研究(ICPOER，Elliott等2000)中2322例有胸片患者，肺动脉扩张报告率为19%，心脏扩大报告率为27%。

证据类型、等级与局限

证据类型：综述文章，回顾历史文献及前瞻性诊断性研究。
PIOPED研究为前瞻性多中心诊断性研究，以血管造影为金标准，样本量1063例。
Greenspan等1982年研究为前瞻性随机盲法诊断性研究，样本量152例。
Chang和Davis 1965年研究为连续病例系列，样本量23例。
Palla等1983年研究为回顾性病例对照研究，样本量374例。
局限性：多数经典描述基于尸检病例和小样本病例系列；CTPA普及前的研究以血管造影为金标准；后续教学对原始定义存在曲解和简化。

对床旁实践的改变

在CTPA时代，这些经典胸片征象因独立诊断价值差，主要用于识别替代诊断和偶发线索，而非直接诊断或排除肺栓塞。
临床医生应理解这些征象实际描述肺栓塞病理生理过程的不同方面（近端动脉扩张、远端少血、外周梗死、继发肺不张），而非孤立诊断标志。
Westermark征应关注区域性血管稀疏而非单纯透亮度增加；Hampton hump的「驼峰」指向内凸的边缘，形态可为圆形或半球形，非简单楔形。
Chang征（降肺动脉短暂性扩张）与Palla征（右降肺动脉「香肠」样畸形）描述不同现象，不应混淆。
原文未明确这些征象可改变急诊或ICU具体处置流程，而是强调其历史演变和诊断局限性。

指南或共识出处

PIOPED研究（Worsley等，1993年发表于胸部影像学杂志）
国际肺栓塞协作注册研究ICPOER（Elliott等，2000年）
原文引用了1910-2000年间多项肺栓塞胸片研究的历史文献

全文中译13 节 · 点击展开

本译文由 AI 依据开放获取原文逐段翻译，供学习参考，可能存在误差，请以原文为准。原文 © Mike Cadogan（LITFL · Life in the Fast Lane），按 CC BY-NC-SA 4.0 许可使用，本译文为翻译改编，并按相同许可提供。出处：Mike Cadogan，「CXR eponyms in pulmonary embolism」，LITFL · Life in the Fast Lane

肺栓塞的经典胸部X线征象命名术语常被作为孤立的征象呈现。实际上，它们描述的是同一疾病过程的不同血管和实质后果：近端肺动脉扩张、远端血管减少、肺梗死和继发性肺不张。它们的历史发展也有相当大的重叠，并且一些现代定义已经偏离了最初的描述。

本综述追溯了Westermark征、Hampton征、Fleischner征、Chang征和Palla征等命名术语的发展，区分了重叠的术语，并探讨了这些征象在现代CTPA时代的意义。

病理生理机制胸部X线表现命名术语

近端肺动脉扩张与阻塞和急性肺动脉高压相关的中央或近端肺动脉显著/扩张 Fleischner征

一过性降支肺动脉扩张既往正常的右或左降支肺动脉新出现的扩张，可能是可逆的 Chang征

右降支肺动脉形态改变近端扩张伴远端突然变细，形成特征性的"香肠样"形态 Palla征

远端血管减少区域性少血伴外周血管标记减弱/消失 Westermark征

外周肺梗死胸膜基底部出血性梗死，具有特征性的向内凸起边缘 Hampton驼峰征

继发性盘状肺不张线状/盘状肺不张；一种间接和非特异性表现 Fleischner线

相关的非命名术语发现：knuckle征描述肺动脉突然终止，不应与Fleischner征、Chang征或Palla征混淆。

历史时间线

1910年 – Otto von Dehn发表了Über röntgenologische Lungenbefunde im Vergleich zu den Ergebnissen der Sektion。他的这项比较胸部X线表现与尸检结果的研究是肺血栓形成X线表现的早期报告。Dehn在一位双侧肺动脉血栓形成且尸检时几乎无肺门淋巴结肿大的患者中观察到stark ausgesprochene Hilusschatten（明显的肺门阴影）。

1931年 – Clarence H. Boswell和Harold D. Palmer发表了Progressive thrombosis of pulmonary artery。他们的病例提供了强有力的X线-病理学关联。胸部X线片显示右肺动脉阴影密度增加，并指出其意义在死亡前未被认识到。异常的肺门/肺动脉阴影被回顾性地与阻塞性血栓相关联。

1936年 – Felix George Fleischner发表了三篇论文，研究肺萎陷、盘状肺不张和基底部水平肺阴影。这些研究奠定了后来被称为Fleischner线的X线表现的基础。

1938年 – Westermark征：远端肺少血

1938年 – Nils Westermark发表了On the roentgen diagnosis of lung embolism，基于26例随后经尸检证实的肺栓塞患者和另外18例通过X线随访演变和恢复过程的临床病例。

他所描述的：无梗死的栓塞产生相对透亮的肺区域，伴外周血管标记减少或消失。中央血管仍可见，但可能在少血区域边缘突然终止。

现代命名术语：Westermark征：栓塞性动脉阻塞远端的区域性肺少血。

被曲解的内容：最初的观察是局部血管减少而非单纯的透亮度增加。尸检系列包括26例患者，而非28例。

1940年——Hampton驼峰征和肺梗死

1940年——Aubrey Otis Hampton和Benjamin Castleman发表了《尸检后胸部远距离X线片与尸检结果的相关性，特别关注肺栓塞和梗死》。他们的研究将死后X线片与详细的大体和显微肺部病理相关联，并提供了关于肺梗死演变和X线形态学的奠基性描述之一。

他们描述的内容：外周胸膜基底部梗死灶，形态多样，具有特征性的向内/心脏侧凸起边缘。

现代命名法：Hampton驼峰征

被曲解的内容："楔形阴影"是有用的简称，但Hampton和Castleman实际描述的是圆形、半球形和截锥形病灶；驼峰来自向内凸起的边缘。

1941年——Fleischner、Aubrey Otis Hampton和Benjamin Castleman发表了《肺内线状影（叶间胸膜炎、肺不张和愈合的梗死）》。他们将盘状肺不张与胸膜疾病和愈合中/已愈合肺梗死引起的线状影区分开来。

1951年——Hanelin和Eyler发表了《肺动脉血栓形成：X线表现》，回顾了5例累及肺主动脉或主要分支的病例。他们描述了梗阻近端的扩张、血栓处的增大或轮廓改变，以及远端血管减少产生的局部透亮度增加。

1958-1962年——Fleischner征和肺动脉增粗

1958年——Felix George Fleischner发表了《肺栓塞》。将血栓相关的肺门增大与动力学压力介导的动脉扩张区分开来，并展示了连续的11 → 14 → 22 → 15 mm变化。

1959年——Fleischner描述了单侧肺血减少伴代偿性对侧肺血增多。这并非Fleischner征的最初描述。

1962年——Fleischner发表了《肺栓塞》，并提供了他对PE的X线表现的综合论述。

现代命名法：Fleischner征=显著的、扩张的近端或中心肺动脉。

独立的命名法：Fleischner线=盘状肺不张。

被曲解的内容：Fleischner并非在1959年首次发现肺动脉增粗。他的贡献主要是血流动力学解释和动态扩张的证明。

1962-1965年——Chang征和肺动脉测量

1962年——C. H. Joseph Chang发表了《1,085例右侧降支肺动脉的正常X线测量值》，为后前位胸部X线片上该血管建立了参考测量值。

1965年4月——Chang和W. Clayton Davis发表了《肺梗死的X线征象》。他们研究了23例连续的肺梗死患者，发现所有病例均有降支肺动脉增粗：19例右侧梗死为17-22 mm，4例左侧梗死为17-26 mm。

1965年12月——Chang发表了《测量右侧降支肺动脉在各种原因引起的肺动脉高压的放射学诊断中的临床应用》。他将该测量方法应用于多种原因引起的肺动脉高压。

现代命名法：Chang征=一过性管径增粗，而非血管截断。

被曲解的内容：突然截断并非Chang最初定义的一部分。

1972年——Murray G. Baron发表了《Fleischner线和肺栓塞》，指出这些线状阴影"通常被称为Fleischner线"。他定义了它们的形态学特征，并强调它们是PE的间接、非特异性表现，由局灶性支气管阻塞和肺不张引起，而非直接显示血管闭塞。

1983年——Palla征和右下肺动脉形态学

1983年——Antonio Palla等发表了《肺栓塞时右下肺动脉的增粗》。他们回顾了374例连续入院的疑似肺栓塞患者，定量比较了确诊PE和未确诊PE患者的右下肺动脉尺寸。

他们所描述的：在急性PE期间，近端右下肺动脉可能变得增粗、致密和显著，远端相对突然变细

现代命名法：Palla征=右下肺动脉增粗和特征性香肠样变形

被扭曲的内容：Palla并非首位描述下肺动脉增粗的人。Palla使用Chang 1962年的正常测量值作为参考标准，但未引用1965年Chang-Davis的论文。后来的作者将Palla征用于几乎任何增粗的右下肺动脉，模糊了它与更早的Chang征的区别。

从描述性征象到诊断证据：1982-2000年

前瞻性评估表明，这些胸部X线表现作为独立诊断试验的效能较差。在PIOPED研究中，Westermark征、中央肺动脉突出、Fleischner征和Hampton驼峰作为独立预测因素对PE的预测价值均较差。

随着CTPA的发展，胸部X线摄影主要成为识别替代诊断和识别偶然线索的工具，而非直接诊断或排除PE。

1982年——Greenspan等发表了《胸部X线摄影在肺栓塞诊断中的准确性》。他们将152例疑似PE患者的胸部X线片随机分配给9名盲法阅片者。该研究显示胸部X线摄影对PE的整体诊断准确性较差，并发现阅片者经验与诊断表现之间无有意义的关系。

1993年——Worsley等发表了《急性肺栓塞患者的胸部X线表现：来自PIOPED研究的观察》。他们回顾了1,063例疑似PE患者的胸片。383例经血管造影证实PE，680例排除PE。该论文定义：

少血=Westermark征

中央肺动脉突出=Fleischner征

胸膜基底部不透光影=Hampton驼峰

所有这些征象对PE的预测价值均较差

2000年——C. Gregory Elliott等发表了国际肺栓塞合作登记处(ICPOER)的研究结果。在2,322例有胸片的患者中，肺动脉增粗报告为19%，而心脏增大为27%，胸膜

名称如何改变了观察结果

这些命名法并非作为五个独立的诊断征象出现的。它们是回顾性地应用于数十年来发展的观察结果，后来的教学逐渐缩小或改变了它们的含义。

Fleischner的血流动力学观察变成了单一的增粗动脉

Chang和Palla尽管描述的是不同的现象，却变成了近义词。

这些名称作为简便术语仍然有用，但原始论文显示了肺栓塞更为相互关联的X线生理学。

原文篇幅较长或含参考文献等附属内容，只翻译了正文部分，其余请阅读原文。

原文图文 · 图 2 张

CXR eponyms in pulmonary embolism

Mike Cadogan

Sep 15, 2026

Home LITFL Eponymythology

The classic chest x-ray eponymous terms of pulmonary embolism are often presented as isolated signs. In reality, they describe different vascular and parenchymal consequences of the same disease process. Proximal pulmonary arterial enlargement, distal vascular depletion, pulmonary infarction and secondary atelectasis. Their historical development also overlaps considerably, and several modern definitions have drifted from the original descriptions.

This review traces the development of the Westermark, Hampton, Fleischner, Chang and Palla eponyms, separates overlapping terminology, and examines what these signs mean in the modern CTPA era.

PathophysiologyCXR findingsEponym

Proximal pulmonary arterial enlargementProminent/dilated central or proximal PA related to obstruction and acute pulmonary hypertensionFleischner sign

Transient descending PA enlargementNew enlargement of a previously normal right or left descending PA, potentially reversibleChang sign

Right descending PA shape distortionProximal enlargement with abrupt distal tapering producing the characteristic “sausage” morphologyPalla sign

Distal vascular depletionRegional oligaemia with attenuated/absent peripheral vascular markingsWestermark sign

Peripheral pulmonary infarctionPleural-based haemorrhagic infarction with a characteristic convex inward marginHampton hump

Secondary plate atelectasisLinear/discoid atelectasis; an indirect and non-specific manifestationFleischner lines

Related non-eponymous finding: the knuckle sign describes abrupt pulmonary arterial termination and should not be conflated with Fleischner, Chang or Palla signs.

Historical timeline

1910 – Otto von Dehn published Über röntgenologische Lungenbefunde im Vergleich zu den Ergebnissen der Sektion. His study comparing chest radiographic appearances with postmortem findings was an early report of radiographic findings in pulmonary thrombosis. Dehn noted stark ausgesprochene Hilusschatten (marked hilar shadows) in a patient with thrombosis of both pulmonary arteries and almost no hilar lymph-node enlargement at autopsy.

1931 – Clarence H. Boswell and Harold D. Palmer published Progressive thrombosis of pulmonary artery. Their case provided a strong radiographic–pathological correlation. The chest radiograph showed an increased density of the shadow of the right pulmonary artery noting that its significance was not recognized before death. An abnormal hilar/pulmonary arterial shadow was retrospectively correlated with an obstructing thrombus.

1936 – Felix George Fleischner published three papers investigating pulmonary collapse, plate-like atelectasis and basal horizontal pulmonary shadows. These establish the basis of the radiographic findings later termed Fleischner lines.

1938 – Westermark sign: distal pulmonary oligaemia

1938 – Nils Westermark published On the roentgen diagnosis of lung embolism, based on 26 patients with pulmonary embolism subsequently confirmed at autopsy and a further 18 clinical cases followed radiographically during evolution and recovery.

What he described: embolism without infarction produced a relatively hyperlucent pulmonary territory with diminished or absent peripheral vascular markings. Central vessels remained visible but could terminate abruptly at the edge of the oligaemic territory.

Modern eponym: Westermark sign: regional pulmonary oligaemia distal to embolic arterial obstruction.

What has been distorted: the original observation was regional vascular depletion rather than hyperlucency alone. The autopsy series comprised 26 patients, not 28.

1940 – Hampton hump and pulmonary infarction

1940 – Aubrey Otis Hampton and Benjamin Castleman published Correlation of postmortem chest teleroentgenograms with autopsy findings with special reference to pulmonary embolism and infarction. Their study correlated postmortem radiographs with detailed gross and microscopic lung pathology and provided one of the foundational descriptions of the evolution and radiographic morphology of pulmonary infarction.

What they described: peripheral pleural-based infarcts with variable morphology and a characteristically convex medial/cardiac margin.

Modern eponym: Hampton hump

What has been distorted: “wedge-shaped opacity” is useful shorthand, but Hampton and Castleman actually described rounded, hemispherical and truncated-cone lesions; the hump came from the convex inward margin.

1941 – Fleischner, Aubrey Otis Hampton and Benjamin Castleman published Linear shadows in the lung (interlobar pleuritis, atelectasis and healed infarction). They distinguished plate-like atelectasis from linear shadows caused by pleural disease and healing/healed pulmonary infarction.

1951 – Hanelin and Eyler published Pulmonary Artery Thrombosis: Roentgen Manifestations reviewing five cases involving the main pulmonary artery or major branches. They described dilatation proximal to the obstruction, enlargement or altered contour at the thrombus, and diminished distal vessels producing regional hyperlucency.

1958–1962 — Fleischner sign and the enlarged pulmonary artery

1958 – Felix George Fleischner published Pulmonary embolism. Separates thrombus-related hilar enlargement from dynamic pressure-mediated arterial dilatation and demonstrates serial 11 → 14 → 22 → 15 mm change.

1959 – Fleischner described unilateral oligaemia with compensatory contralateral pleonemia. This was not the original description of the Fleischner sign.

1962 – Fleischner published Pulmonary embolism and provided his synthesis of the roentgen manifestations of PE.

Modern eponym: Fleischner sign = prominent, dilated proximal or central PA.

Separate eponym: Fleischner lines = plate, discoid atelectasis.

What has been distorted: Fleischner did not first discover PA enlargement in 1959. His contribution was largely the haemodynamic explanation and demonstration of dynamic dilatation.

1962–1965 — Chang sign and pulmonary artery measurement

1962 – C. H. Joseph Chang published The normal roentgenographic measurement of the right descending pulmonary artery in 1,085 cases, establishing reference measurements for the vessel on PA chest radiography.

April 1965 – Chang and W. Clayton Davis published A Roentgen sign of Pulmonary Infarction. They studied 23 consecutive patients with pulmonary infarction and found enlargement of a descending pulmonary artery in all cases : 17–22 mm in 19 right-sided infarcts and 17–26 mm in four left-sided infarcts.

December 1965 – Chang published Clinical application of the measurement of the right descending pulmonary artery in the radiological diagnosis of pulmonary hypertensions from various causes. He applied the measurement method to pulmonary hypertension from several causes.

Modern eponym: Chang sign = transient calibre enlargement, not vessel amputation.

What has been distorted: abrupt cutoff was not part of Chang’s original definition.

1972 – Murray G. Baron published Fleischner lines and pulmonary emboli stating that the linear shadows were “commonly referred to as Fleischner lines”. He defined their morphology and emphasised that they were an indirect, non-specific manifestation of PE caused by focal bronchial obstruction and atelectasis rather than by direct visualisation of vascular occlusion.

1983 – Palla sign and right descending pulmonary artery morphology

1983 – Antonio Palla et al. published Enlargement of the right descending pulmonary artery in pulmonary embolism. They reviewed 374 consecutive patients admitted with suspected pulmonary embolism and quantitatively compared right descending pulmonary artery dimensions in patients with and without confirmed PE.

What they described: during acute PE, the proximal right descending pulmonary artery could become enlarged, dense and conspicuous, with relatively abrupt distal tapering

Modern eponym: Palla sign = enlargement and characteristic sausage-shape distortion of the right descending pulmonary artery

What has been distorted: Palla was not the first to describe descending pulmonary arterial enlargement. Palla used Chang’s 1962 normal measurements as a reference standard but did not cite the 1965 Chang–Davis paper. Later authors use Palla sign for almost any enlarged right descending pulmonary artery, blurring its distinction from the earlier Chang sign.

From descriptive signs to diagnostic evidence: 1982–2000

Prospective evaluation has demonstrated that these chest x-ray findings are poor standalone diagnostic tests. In PIOPED, Westermark sign, prominent central PA, Fleischner sign and Hampton hump were all poor independent predictors of PE.

With the development of CTPA, chest radiography became primarily a tool for identifying alternative diagnoses and recognising occasional clues rather than directly diagnosing or excluding PE.

1982 – Greenspan et al published Accuracy of the chest radiograph in diagnosis of pulmonary embolism. They randomised chest radiographs from 152 patients suspected of PE to nine blinded readers. The study demonstrated poor overall diagnostic accuracy of chest radiography for PE and found no meaningful relationship between reader experience and performance.

1993 – Worsley et al. published Chest Radiographic Findings in Patients With Acute Pulmonary Embolism: Observations From the PIOPED Study.. They reviewed CXRs from 1,063 patients with suspected PE. 383 had angiographically confirmed PE and 680 had PE excluded. The paper defines:

oligaemia = Westermark sign

prominent central pulmonary artery = Fleischner sign

pleural-based opacity = Hampton hump

All were poor predictors of PE

2000 – C. Gregory Elliott et al published findings from the International Cooperative Pulmonary Embolism Registry (ICPOER). Among 2,322 patients with CXRs, pulmonary artery enlargement was reported in 19%, compared with cardiomegaly 27%, pleura

Eponymythology

How the names changed the observations

These eponyms did not arise as five discrete diagnostic signs. They were applied retrospectively to observations developed over several decades, and later teaching progressively narrowed or altered their meanings.

Westermark’s vascular depletion became “hyperlucency”

Hampton’s variable infarct morphology became a “wedge”

Fleischner’s haemodynamic observations became a single enlarged artery

Chang and Palla became near-synonyms despite describing different phenomena.

The names remain useful shorthand, but the original papers show a much more interconnected radiographic physiology of pulmonary embolism.

References

Original articles

Fleischner F. Atelektase und gerichteter Kollaps der Lunge. Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin, 1936, 53, 607-625.

Fleischner F. Plattenformige Atelektasen in der Unterlappen der Lunge. Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin 1936; 54: 315-321.

Fleischner F. Über das Wesen der basalen horizontalen Schattenstreifen im Lungenfeld. Wiener Archiv für innere Medizin 1936; 28: 461-480.

Westermark N. On the roentgen diagnosis of lung embolism: brief review of the incidence, pathology and clinical symptoms of lung embolism. Acta Radiologica 1938; 19(4): 57-372.

Hampton AO, Castleman B. Correlation of postmortem chest teleroentgenograms with autopsy findings with special reference to pulmonary embolism and infarction. American journal of roentgenology and radium therapy. 1940; 43: 305-326

Fleischner F, Hampton AO, Castleman B. Linear shadows in the lung (interlobar pleuritis, atelectasis and healed infarction). Am J Roentgenol 1941; 46(5): 610-618

Chang CH. The normal roentgenographic measurement of the right descending pulmonary artery in 1,085 cases. Am J Roentgenol Radium Ther Nucl Med. 1962; 87: 929-35.

Chang CH, Davis WC. A Roentgen sign of Pulmonary Infarction. Clin Radiol. 1965 Apr;16:141-7.

Chang CH. The normal roentgenographic measurement of the right descending pulmonary artery in 1,085 cases and its clinical application. Part II. Clinical application of the measurement of the right descending pulmonary artery in the radiological diagnosis of pulmonary hypertensions from various causes. Nagoya J med. Sci. 1965;28:67-80.

Palla A, Donnamaria V, Petruzzelli S, Rossi G, Riccetti G, Giuntini C. Enlargement of the right descending pulmonary artery in pulmonary embolism. AJR Am J Roentgenol. 1983; 141(3): 513-7.

Review articles

Dehn O v. Über röntgenologische Lungenbefunde im Vergleich zu den Ergebnissen der Sektion. Medizinische Klinik 1910; 6: 863–864.

Boswell CH and Palmer HP. Progressive thrombosis of pulmonary artery, Archives of Internal Medicine. 1931; 47: 799-805.

Hanelin J, Eyler WR. Pulmonary Artery Thrombosis: Roentgen Manifestations. Radiology. 1951;56(5):689-703

Laur A. Roentgen diagnosis of pulmonary embolism and its differentiation from myocardial infarction. Am J Roentgenol Radium Ther Nucl Med. 1963 Sep;90:632-7

Bedard CK, Bone RC. Westermark’s sign in the diagnosis of pulmonary emboli in patients with the adult respiratory distress syndrome. Crit Care Med. 1977 May-Jun;5(3):137-40.

Greenspan RH, Ravin CE, Polansky SM, McLoud TC. Accuracy of the chest radiograph in diagnosis of pulmonary embolism. Invest Radiol. 1982 Nov-Dec;17(6):539-43.

Worsley DF et al. Chest Radiographic Findings in Patients With Acute Pulmonary Embolism: Observations From the PIOPED Study. Radiology. 1993 Oct;189(1):133-6.

Velusamy M, Patel N, Talley JD. The chest X-ray in the diagnosis of acute pulmonary embolism: Westermark’s sign. J Ark Med Soc. 1995 Mar;91(10):501-2

Piazza G, Goldhaber SZ. Acute pulmonary embolism: part I: epidemiology and diagnosis. Circulation. 2006 Jul 11;114(2):e28-32.

Pipavath SN, Godwin JD. Acute Pulmonary Thromboembolism: A Historical Perspective. AJR Am J Roentgenol. 2008; 191(3): 639-41

Taylor BT, Pezzo SP, Rumbak M. Palla’s sign and Hampton’s hump in pulmonary embolism. Respiration. 2010; 80(6): 568.

Ladeiras-Lopes R, Neto A, Costa C, Sousa M, Ferreira P, Dias VP, Ribeiro VG. Hampton’s hump and Palla’s sign in pulmonary embolism. Circulation. 2013 May 7;127(18):1914-5

Hsu CW, Su HY. Palla’s sign and Hampton’s hump in pulmonary embolism. QJM. 2017 Jan;110(1):49-50.

Shawn TS, Yan LX, Lateef F. The chest X ray in pulmonary embolism: Westermark sign, Hampton’s Hump and Palla’s sign. What’s the difference?. Jpournal of Acute Disease 2018; 7: 99-102

Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. Chest. 2000; 118(1): 33-8.

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