This case underscores the diagnostic value of chest X-ray in acute pulmonary thromboembolism (PTE), highlighting the significance of recognizing classical radiographic signs such as Westermark’s, Palla’s, Fleischner’s and Chang’s signs.

While computed tomography pulmonary angiography (CTPA) remains the definitive diagnostic tool, the role of chest X-ray (CXR) in the initial evaluation of suspected PTE, especially in emergency settings, should be acknowledged. Early detection through CXR can facilitate prompt management, improving patient outcomes.

PTE can range from asymptomatic cases to severe presentations with cardiogenic shock.

We report a 67-year-old male with diabetes and hypertension, presenting with progressive dyspnea and hemodynamic instability.

Clinical examination revealed sinus tachycardia, right ventricular dysfunction on echocardiography, and elevated biomarkers indicative of PTE.

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