The overlooked value of chest X-ray in acute pulmonary thromboembolism diagnosis

Acute pulmonary thromboembolism (PTE) can range from asymptomatic cases to severe presentations with cardiogenic shock. We report a 67-year-old male with diabetes and hypertension, presenting with progressive dyspnea and hemodynamic instability. Clinical examination revealed sinus tachycardia, right ventricular dysfunction on echocardiography, and elevated biomarkers indicative of PTE. Chest X-ray showed classic signs including Westermark's, Palla's, Fleischner's and Chang's signs, raising suspicion for PTE, which was confirmed via CT pulmonary angiogram showing extensive thrombi. The patient was treated with intravenous thrombolysis and anticoagulation, resulting in clinical improvement and normalization of imaging findings. This case underscores the diagnostic relevance of chest X-ray in emergency settings for suspected PTE.