Fleischner sign: prominent dilated central pulmonary artery. Enlargement can be associated with massive embolus enlarging the luminal diameter of the proximal artery in the acute setting; or pulmonary hypertension in the subacute to chronic setting
Occurs most commonly in the setting of massive pulmonary embolism (defined angiographically as involving 50% or more of the major pulmonary artery branches) but has a relatively low sensitivity in diagnosis
A key ancillary finding is the abrupt tapering of the occluded pulmonary artery distally, creating the ‘knuckle sign‘ (best seen on CTPA rather than CXR)
- (A) enlargement of the right interlobar artery (arrow).
- (B) Angiogram confirms the presence of multiple filling defects representing multiple emboli and a distended right interlobar artery (arrow).
- Nils Westermark (1892 – 1980) [Westermark sign 1938]
- Aubrey Otis Hampton (1900 – 1955) [Hampton hump 1940]
- Felix George Fleischner (1893 – 1969) [Fleischner sign 1959]
- C. H. Joseph Chang (1929 – 2017) [Chang sign 1965]
- Antonio Palla (1950 – ) [Palla sign 1983]
- Fleischner’s sign
- Fleischner FG. Pulmonary embolism. Can Med Assoc J. 1958 May 1; 78(9): 653–660. [PMC1829877]
- Fleischner F. Unilateral pulmonary embolism with increased compensatory circulation through the unoccluded lung. Radiology 1959; 73: 591-597
- Fleischner F. Roentgen diagnosis of pulmonary embolism. Heart Bull. 1961 Nov-Dec;10:104-7. [PMID 13893511]
- Fleischner FG. Pulmonary embolism. Clin Radiol. 1962; 13(3): 169-82. [PMID 13893510]
- Williams JR, Wilcox WC. Pulmonary embolism: roentgenographic and angiographic considerations. AJR Am J Roentgenol. 1963; 89: 333.
- Stein PD, Athanasoulis C, Greenspan RH, et al. Relation of plain chest radiographic findings to pulmonary arterial pressure and arterial blood oxygen levels in patients with acute pulmonary embolism. Am J Cardiol. 1992;69:394 [PMID 1734655]