Should transesophageal echocardiography become a routine test in patients with suspected pulmonary thromboembolism?

Pulmonary thromboembolism presents in two clinical subsets: acute pulmonary embolism (PE) with or without right heart thrombi or paradoxical embolism and chronic thromboembolic pulmonary, hypertension (CTEPH). Both PE and CTE PH have been underdiagnosed and carry high mortality rates. Acute massive P E is a hemodynamic entity leading to right ventricular overload readily ide ntified with the use of transthoracic Echocardiography. Transesophageal ech ocardiography (TEE) is a noninvasive bedside technique that has high diagno stic accuracy for the detection of central pulmonary thromboembolism. Due t o the high prevalence of central pulmonary thromboembolism in acute PE, TEE is a useful method to provide the necessary proof for the institution of t hrombolytic therapy, lit the subset of patients with acute PE combined with right heart thrombi or paradoxical embolism, TEE is the technique of choic e to guide surgery. CTEPH presents as primary, pulmonary hypertension, but it has become a surgically curable disease. TEE is a fast, fairly sensitive , and highly specific diagnostic bedside modality to select surgical candid ates with CTEPH. TEE should become a routine test in patients with suspecte d massive acute PE, suspected right heart thrombi, or paradoxical embolism associated with acute pulmonary embolism and in patients with primary pulmo nary hypertension to select those having CTEPH who are suitable for surgery .