ECHOCARDIOGRAPHIC DIAGNOSIS OF ACUTE PULM ONARY-EMBOLISM

The technology of echocardiographic imaging is now widely available an d has become increasingly important in the diagnosis of severe pulmona ry embolism. in this setting transthoracic twodimensional echocardiogr aphy (TTE) permits a rapid and non-invasive bed-side assessment of rig ht ventricular size and systolic function. Doppler techniques facilita te precise measurements of pulmonary arterial pressures. These paramet ers can be easily followed after initiating therapy and allow to recog nize patients refractory to the chosen therapeutic regimen. With trans esophageal echocardiography (TEE), as well as with TTE, direct visuali zation of thrombembolic material within the central pulmonary arteries or the right heart chambers is possible. TEE, however, is more sensit ive than TTE in detecting thrombotic or embolic material. It is also s uperior in the diagnosis of a patent foramen ovale which may indicate impending paradoxical embolism. The role of intravascular ultrasound i maging 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.