TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF PULMONARY-EMBOLISM WITH ACUTE COR-PULMONALE - A COMPARISON WITH RADIOLOGICAL PROCEDURES

Objective: The goal of the study was to assess prospectively the value of transesophageal echocardiography (TEE) for the diagnosis of massiv e pulmonary embolism complicated by acute cor pulmonale. Design: A pro spective study conducted on 44 consecutive patients. Setting: A genera l intensive care unit (ICU) of a university hospital, Patients and met hods: Between May 95 and October 96, 44 consecutive patients with clin ically suspected acute pulmonary embolism underwent transthoracic echo cardiography (TTE), completed by TEE when acute cor pulmonale was pres ent (30 patients). The results of the echocardiographic studies were c ompared with radiological investigations by helical CT or contrast ang iography. Results: The high sensitivity and specificity of the presenc e of acute cor pulmonale on TTE for the diagnosis of pulmonary embolis m was confirmed. Nineteen patients only underwent TEE. The sensitivity and the specificity of TEE in detecting a proximal pulmonary embolism were 84 % and 84 %, respectively. Its main limitation concerned the l eft pulmonary artery, in which only one thrombus was visualized by TEE whereas six were present on helical CT, and lobar pulmonary arteries which could not be visualized with TEE. Thus, the overall sensitivity of TEE for the detection of pulmonary embolism with acute cor pulmonal e was only 58 %. Conclusion: In comparison with radiological procedure s, TEE had limited accuracy for detecting pulmonary embolism with acut e cor pulmonale, When the pulmonary embolism was located in the main o r right pulmonary artery, TEE could clarify the diagnosis within a few minutes without further invasive diagnostic procedures. However, a ne gative TEE did not exclude left proximal or lobar pulmonary embolism.