All signs in Radiopedia

Chest
Pulm.embolism
Oligemia (the Westermark sign),
Prominent central pulmonary artery (the Fleischner sign),
Pleural-based area of increased opacity (the Hampton hump)
Palla’s sign : Enlarged Descending br.of Rt. Pulm.artery

1. Westermark sign (area of peripheral oligemia) : is a sign of pulmonary embolus (PE) seen on CXR
Along with Fleishner sign and Hampton hump, it makes 1 of the 3 described signs of pulmonary embolus on CXR.
Pathology :
In one study (PIOPED) this sign was present on ~10% of CXR of patients with confirmed PE.

The theory behind the sign is either obstruction of the pulmonary artery or distal vasoconstriction in hypoxic lung.
Radiographic features :
- Focal peripheral hyperlucency secondary to oligaemia
- Central pulmonary vessels may also be dilated
History and etymology : Dr. Nils Westermark (1892-1980) was a Swedish radiologist who first described this sign.

2. Fleischner sign is a prominent central artery that can be caused either by pulmonary hypertension that develops
or by distension of the vessel by a large pulmonary embolus. It can be seen on CXR and CTPA
It is seen most commonly in the setting of massive pulmonary embolism (defined angiographically as involving 50%
or more of the major pulmonary artery branches). It has a low sensitivity but high specificity.
History and etymology : It is named after Felix G. Fleischner, a German-American radiologist, 1ST described it in 1961.

3. Knuckle sign : refers to the abrupt tapering or cutoff of a pulmonary artery secondary to embolus. It is better
visualised on CTPA scan than chest x-ray. This is an important ancillary finding in pulmonary embolism (PE), and
often associated with the Fleischner sign of dilated central pulmonary arteries.

4. The Chang sign refers to the dilatation and abrupt change in calibre of the main pulmonary artery due to
pulmonary embolism.
History and etymology : It is named after C. H. (Joseph) Chang, an American radiologist, who first described it in 1965

5. Hampton hump refers to a dome-shaped, pleural-based opacification in the lung most commonly due to
pulmonary embolism and lung infarction (it can also result from other causes of pulmonary infarction (e.g.
vascular occlusion due to angioinvasive aspergillosis). While a pulmonary artery embolism is expected to result in
a wedge-shaped infarction, the expected apex of this infarction may be spared because of bronchial arterial
circulation in this part, leading to the characteristic rounded appearance of a Hampton hump.
Opacification occurs secondary to haemorrhage due to the dual blood supply from the bronchial arteries.
If the underlying parenchyma (at area of opacification), doesn't undergo infarction, the Hampton hump will
resolve within a week by keeping it typical configuration. This is referred to as the melting sign because its
resolution resembles a melting ice cube.
In the case of infarction (at area of opacification), it takes months to resolve, and it often leaves a linear scar.
Hampton hump : wedge-shaped (less often rounded) juxtapleural opacification without air bronchograms
more often in the lower lobes
- In the case of pulmonary haemorrhage - infarction : the opacities resolve, usually within a week, by
maintaining their shape (the so called "melting sign")
- In the case of pulm. haemorrhage + infarction : it requires months to heal and will leave a linear scar
History and etymology : It was originally described in 1940 by Aubrey Otis Hampton, an American radiologist.