In chest radiography, the Westermark sign is a sign that represents a focus of oligemia (hypovolemia) (leading to collapse of vessel) seen distal to a pulmonary embolism (PE). While the chest x-ray is normal in the majority of PE cases, the Westermark sign is seen in 2% of patients.
Essentially, this is a plain X-ray version of a filling defect as seen on computed tomography pulmonary arteriogram.
The sign results from a combination of:
Sensitivity and specificity
The Westermark sign, like Hampton's hump (a wedge shaped, pleural based consolidation associated with pulmonary infarction), has a low sensitivity (11%) and high specificity (92%) for the diagnosis of pulmonary embolism. Put more simply, the Westermark sign is seldom seen in PE, but when visible on a chest X-ray, it is strongly indicative of PE.
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