Enlargement of the central pulmonary artery and elevated hemidiaphragm in the chest X-ray is known as:

Appeared in: DSSSB 12 August 2024

Explanation

Fleischner's sign is defined as the dilation of the central pulmonary artery (pulmonary trunk and/or main right/left pulmonary arteries) visible on a chest X-ray.
This enlargement is caused by the physical presence of a large embolus distending the artery or by increased pressure (pulmonary hypertension) from more distal clots.
The associated finding of an elevated hemidiaphragm is often due to atelectasis (reduced lung volume) in the lower lobes, which is a common non-specific finding in pulmonary embolism.

Option A: The melting sign describes the resolution pattern of a pulmonary infarct (Hampton's hump) over time, not the initial finding of an enlarged artery.
Option B: Palla's sign specifically refers to the enlargement of the right descending pulmonary artery, which is a different and more distal anatomical location than the central pulmonary artery mentioned in the question.
Option D: Westermarck sign is a finding of oligemia, meaning decreased blood flow and vascular markings distal to an embolus. This appears as a region of hyperlucency (darker lung), not an enlarged vessel.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Radiographic signs of Pulmonary Embolism as background academic context rather than a clinical decision trigger.
Recognizing classic X-ray signs of pulmonary embolism (PE) is a crucial skill for nurses, as it can prompt early intervention and escalation of care for a life-threatening condition.
While these signs are classic, the most common finding on a chest X-ray in a patient with PE is 'normal' or shows non-specific abnormalities like atelectasis or a small pleural effusion. A high index of suspicion is key.
The definitive diagnosis of PE is typically made with a CT Pulmonary Angiogram (CTPA), but the initial chest X-ray provides valuable clues.

How to Approach the Question

First, identify the key descriptive phrase in the question stem: 'Enlargement of the central pulmonary artery'.
Next, recall or look up the definitions of the eponyms (named signs) provided in the options.
Systematically compare the description in the question to the definition of each sign.
Fleischner's sign directly matches the description of a prominent central pulmonary artery.
Differentiate from other signs by their specific anatomical location (e.g., Palla's sign is the right descending artery) or characteristic (e.g., Westermarck sign is decreased vascularity).

Concept Tested & Keywords

Concept Tested: Radiographic signs of Pulmonary Embolism
Stem keywords: enlargement, central pulmonary artery, elevated hemidiaphragm, chest X-ray
Lead-in keywords: known as

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Practise the full DSSSB 12 August 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.