Hampton’s Hump and Palla’s Sign in Pulmonary Embolism

Abstract

A 33-year-old female smoker came to our emergency department complaining of dyspnea, pleuritic left chest pain, and an episode of mild hemoptysis. One week previously, she had experienced left calf pain. There was no history of recent trauma or immobilization. Her only medication was an oral contraceptive. On admission, her heart rate was 110 beats per minute in sinus rhythm, with a normal physical examination and arterial blood gases and without evidence of right ventricular strain on ECG (Figure 1). A chest x-ray showed a wedgeshaped peripheral opacity in the lower half of the left lung field (Hampton's hump; Figure 2, long arrow) and an enlarged right descending pulmonary artery (Palla's sign; Figure 2, short arrow). Plasma D-dimers were elevated (2.3 μg/mL; normal value, <0.5 μg/mL). The patient had a chest computed tomography contrast scan that showed luminal filling defects in the left pulmonary artery (Figure 3, asterisk) and right segmental pulmonary arteries, as well as a consolidation area in the left lower lobe probably associated with lung infarction.The patient had normal cardiac biomarkers and a normal transthoracic echocardiogram. Anticoagulation was initiated, and the patient was admitted to our intermediate care unit.Although contrast-enhanced thoracic computed tomography scan allows a rapid and straightforward diagnosis of pulmonary embolism, older radiological findings should not be forgotten. The Hampton's hump, described in 1940 by the radiologist Aubrey Hampton, consists of a wedge-shaped opacity of the peripheral lung field.1 The Palla's sign was named after the description by Antonio Palla of an association between pulmonary embolism and a chest x-ray sign of right descending pulmonary artery enlargement.2 The simultaneous presence of these findings in chest x-ray is infrequent 3 but is a valuable aid in the diagnosis of pulmonary embolism, especially in patients at risk of complications with contrastenhanced imaging techniques. DisclosuresNone.

Hampton’s hump, Westermark’s sign and Palla’s sign in acute pulmonary thromboembolism: a rare concurrence

“…There are descriptions of the co-occurrence of Westermark’s and Palla’s signs, Hampton’s hump and Palla’s signs, as well as Hampton’s hump and Westermark’s signs in acute pulmonary thromboembolism (PTE) 2–5. However, to the best of our knowledge, the concurrence of Hampton’s hump, Westermark’s sign and Palla’s sign in the same patient have not been reported.…”

Diagnosis of Pulmonary Embolism

“…Most often, a chest X-ray reveals nonspecific abnormal findings such as effusion, infiltrates, or atelectasis. Certain signs with interesting names that have been observed on chest radiograph imaging are mentioned in Table 4 [59][60][61].…”