Purpose: To determine the sensitivity, specificity, and positive and negative predictive values of chest radiographic findings in patients suspected of having acute pulmonary embolism (PE).

Materials and methods: Chest radiographs of 1,063 patients with suspected PE were reviewed. PE was confirmed angiographically in 383 patients and excluded in 680 patients.

Results: The chest radiograph was interpreted as normal in only 12% of patients with PE. The most common chest radiographic finding in patients with PE was atelectasis and/or parenchymal areas of increased opacity; however, the prevalence was not significantly different from that in patients without PE. Oligemia (the Westermark sign), prominent central pulmonary artery (the Fleischner sign), pleural-based area of increased opacity (the Hampton hump), vascular redistribution, pleural effusion, elevated diaphragm, and enlarged hilum were also poor predictors of PE.

Conclusion: Although chest radiographs are essential in the investigation of suspected PE, their main value is to exclude diagnoses that clinically mimic PE and to aid in the interpretation of the ventilation-perfusion scan.