IMPACT OF THE INCIDENTAL DIAGNOSIS OF CLINICALLY UNSUSPECTED CENTRAL PULMONARY-ARTERY THROMBOEMBOLISM IN TREATMENT OF CRITICALLY ILL PATIENTS

Mortality is high in unrecognized pulmonary embolism (PE), but the dia gnosis is difficult to establish, especially in patients with coexisti ng cardiopulmonary disorders. We describe a group of 14 patients with pulmonary thromboemboli in whom transesophageal echocardiography (TEE) performed for coexisting cardiopulmonary conditions established the c linical diagnosis of PE not suspected prior to TEE. The patients had i nitial clinical diagnoses of heart failure (eight patients), cardiogen ic shock (two patients), atrial septal defect (two patients), aortic d issection (one patient), and pneumonia (one patient). Thirteen patient s had risk factors for PE. Transthoracic echocardiography (TTE) demons trated right heart strain in eight patients but did not visualize PE i n any of the patients. The TEE diagnosis of occult central pulmonary a rtery thromboembolism changed treatment in all 14 patients. Ten of the 14 patients were successfully discharged from the hospital. We conclu de that occult central pulmonary artery thromboemboli are not uncommon in patients presenting with acute cardiopulmonary disorders and the p resence of risk factors for PE and right heart strain on TTE should al ert the physician to suspect PE. If and when TEE is performed in patie nts with acute cardiopulmonary disorders with risk factors for PE and right heart strain, the physician should evaluate the main pulmonary a rtery and its branches for central pulmonary artery thromboemboli.