Correct!
3. The frontal chest radiograph shows no specific abnormalities
The frontal chest radiograph shows slight widening of the mediastinum with a prominent aortic arch, but this appearance is well within the normal range for a portable, frontal chest radiograph. No specific features to suggest an acute aortic syndrome are present, but it is well-recognized that acute aortic syndromes often present with few or non-specific findings at chest radiography, and chest radiographs may even be normal in this condition. No focal consolidation or pleural effusion are present. The right lung appears relatively “hyperlucent” compared to the left lung, which could be interpreted as Westermark’s sign. Westermark’s sign represents decreased pulmonary vascularity due to mechanical obstruction or reflex vasoconstriction due to pulmonary embolism. This chest radiograph sign is very non-specific and typically the hyperlucency that accompanies this sign is far more commonly caused by technical considerations, such as patient rotation, or obstructive lung disease, rather than acute pulmonary embolism. The chest radiograph shown in Figure 1 shows slight left anterior oblique rotation, which is likely the cause of the relative hyperlucency of the right hemithorax. The pulmonary vascularity is not grossly asymmetrically decreased on the right, nor is the right hilum noticeably enlarged, as may occur with acute pulmonary embolism, and therefore Westermark’s sign is not an appropriate description for the appearance of the chest radiograph shown in Figure 1.
The patient’s d-dimer level was within the normal range.
Which of the following statements is the most appropriate next step for the management of this patient? (Click on the correct answer to proceed to the fifth of nine pages)