Role of echocardiography in acute pulmonary embolism

Abstract

Although pulmonary embolism (PE)-related mortality rate has decreased because of prompt diagnosis and effective therapy use, acute PE remains a potentially lethal disease. Due to its increasing prevalence, clinicians should pay attention to diagnosing and managing patients with acute PE. Echocardiography is the most commonly used method for diagnosing and managing acute PE; it also provides clues about hemodynamic instability in an emergency situation. It has been validated in the early risk stratification and impacts management strategies for treating acute PE. In hemodynamically unstable patients with acute PE, echocardiographic detection of right ventricular dysfunction is an indication for administering thrombolytics. In this review article, we discuss the role of echocardiography in the diagnosis and management of patients with acute PE.

Keywords: Diagnosis; Echocardiography; Management; Pulmonary embolism.

Figure 1

Typical case of an acute pulmonary embolism (PE) in a 33-year-old man. The initial chest radiography is normal (A). The electrocardiogram demonstrates sinus tachycardia, S wave in lead I (S1), Q wave in the lead III (Q3), T wave inversion in lead III (T3), and precordial leads V1–3 (B). Echocardiography shows D-shaped left ventricle (C, arrowheads), McConnell’s sign (D, arrow), thrombus in the main pulmonary artery (E), mid-systolic notching in the pulsed-wave Doppler tracing of right ventricular outflow tract (F), increased maximal velocity of tricuspid regurgitation (G), and decreased right ventricular contractility assessed by tricuspid annular plane systolic excursion (H). RV, right ventricle; LV, left ventricle; RA, right atrium; Ao, aorta; MPA, main pulmonary artery; TRPG, tricuspid valve peak systolic gradient; TAPSE, tricuspid annular plane systolic excursion.

Figure 2

Schematic illustration of echocardiographic findings can be found in acute pulmonary embolism. RA, right atrium; RV, right ventricle; LA, left atrium; TR Vmax, maximal velocity of tricuspid regurgitation; TAPSE, tricuspid annular plane systolic excursion; TA, tricuspid annulus; IVC, inferior vena cava; PA, pulmonary artery; AcT, acceleration time of right ventricular outflow tract; IVS, interventricular septum; LV, left ventricle; LVEF, left ventricular ejection fraction.