Hampton’s Hump and Palla’s Sign in Pulmonary Embolism
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 wedge-shaped 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 infrequent3 but is a valuable aid in the diagnosis of pulmonary embolism, especially in patients at risk of complications with contrast-enhanced imaging techniques.
- © 2013 American Heart Association, Inc.