Echocardiography and Pulmonary Embolism

Echocardiography is a useful prognostic and diagnostic tool in the management of acute pulmonary embolism. Qualitative and quantitative signs of right ventricular enlargement and dysfunction are essential for risk stratification of patients with acute pulmonary embolism. With the advancement of point-of-care cardiac ultrasound, bedside cardiac ultrasound can be employed in the rapid evaluation of unstable or undifferentiated patients with signs and symptoms of pulmonary embolism. Features associated with high mortality, such as clot-in-transit and a patent foramen ovale are diagnosed with echocardiography. More recently, echocardiographic assessment of cardiac output can help identify normotensive patients in subclinical obstructive shock. Acute and chronic pulmonary embolism may be ascertained with specific echocardiographic features such as the 60/60 sign and the right ventricular wall thickness. Newer echocardiographic techniques such as right ventricular longitudinal strain imaging and three-dimensional echocardiography have been developed but are not yet available ubiquitously. Echocardiography is also employed in practice to monitor response to treatment and for the development of chronic thromboembolic pulmonary hypertension.