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INTERESTING IMAGES
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 192-193

Hampton's Hump and Westermark Sign: An Interesting X-Ray View


Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India

Date of Submission27-Nov-2018
Date of Decision19-Mar-2019
Date of Acceptance13-Feb-2019
Date of Web Publication18-Dec-2019

Correspondence Address:
Deepak Ramchand Nenwani
Room No. 115, Madras Medical College Men's Hostel, Near Broadway Bus Stand, Opposite to Tamil Nadu Public Service Commission Office, Chennai - 600 003, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_47_18

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How to cite this article:
Nenwani DR, Shankar GR, Kumar GP, Rajan JN. Hampton's Hump and Westermark Sign: An Interesting X-Ray View. J Indian Acad Echocardiogr Cardiovasc Imaging 2019;3:192-3

How to cite this URL:
Nenwani DR, Shankar GR, Kumar GP, Rajan JN. Hampton's Hump and Westermark Sign: An Interesting X-Ray View. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2019 [cited 2020 Aug 14];3:192-3. Available from: http://www.jiaecho.org/text.asp?2019/3/3/192/273300



A 42-year-old female admitted with chief complaints of dyspnea for 3 weeks of NYHA II Class with sudden worsening of dyspnea for the last 2 days of NYHA IV Class. The patient also complained of chest pain and cough for 2 days and orthopnea for 1 day. His medical history was unremarkable. Electrocardiogram took suggestive of sinus tachycardia along with S wave in Lead I, Q wave in Lead III, and inverted T wave in Lead III. Chest X-ray done showed both Hampton's hump on the left side of chest and Westermark sign in the same X-ray film. Hampton's hump is peripheral wedge-shaped opacity abutting the pleura, signifying pulmonary infarct distal to pulmonary embolism.[1] Hampton's hump present on the right side of chest was suggestive of pulmonary infarct [Figure 1].
Figure 1: Anteroposterior view suggestive of Hampton's hump (arrow)

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Chest X-ray also showed collapse of right lower lobe of the lung [Figure 2]. Westermark sign is a focal area of oligemia leading to collapse of vessel seen distal to pulmonary embolism.[2] Westermark sign was seen in the left lateral view of chest radiogram in the right upper zone and middle zone [Figure 2].
Figure 2: Lateral view of chest X-ray (white arrow – Westermark sign, red arrow – collapse lung)

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Computed tomographic (CT) angiography is suggestive of total occlusion of the right pulmonary artery and partial occlusion of the left pulmonary artery [Figure 3]. Occlusive thrombus was also present in multiple other peripheral branches of the pulmonary artery. CT scan also confirms the presence of right lower lobe collapse of the lung. The patient was treated with intravenous bolus tenecteplase followed by heparin infusion for 48 h. The patient was started on warfarin. Echocardiography before and after thrombolysis showed persistent of thrombus. The patient after initial stabilization was later referred for surgery for further management.
Figure 3: Computed tomographic scan suggestive of pulmonary embolism with right lower lobe lung collapse (white arrow)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to acknowledge technical help for echocardiography machine and X-ray Image from the Department of Cardiology, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McGrath BM, Groom AG. Images in clinical medicine. Hampton's hump. N Engl J Med 2013;368:2219.  Back to cited text no. 1
    
2.
Krishnan AS, Barrett T. Images in clinical medicine. Westermark sign in pulmonary embolism. N Engl J Med 2012;366:e16.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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