ECHOCARDIOGRAPHIC DIAGNOSIS OF ACUTE PULMONARY-EMBOLISM

The technology of echocardiographic imaging is now widely available and has become increasingly important in the diagnosis of severe pulmonary embolism. in this setting transthoracic twodimensional echocardiography (TTE) permits a rapid and non-invasive bed-side assessment of right ventricular size and systolic function. Doppler techniques facilitate precise measurements of pulmonary arterial pressures. These parameters can be easily followed after initiating therapy and allow to recognize patients refractory to the chosen therapeutic regimen. With transesophageal echocardiography (TEE), as well as with TTE, direct visualization of thrombembolic material within the central pulmonary arteries or the right heart chambers is possible. TEE, however, is more sensitive than TTE in detecting thrombotic or embolic material. It is also superior in the diagnosis of a patent foramen ovale which may indicate impending paradoxical embolism. The role of intravascular ultrasound imaging in clinical practice is not clear yet. It may be helpful in the localization and differential diagnosis of thromboembolic material in the pulmonary vascular bed.