ECHOCARDIOGRAPHY IN PULMONARY-EMBOLISM DISEASE

Pulmonary embolism is a very common disease often misdiagnosed, becaus e of variable and nonspecific clinical manifestations. Therefore it ha s a burden of high mortality, particularly in nonrecognized cases. Pul monary angiography, which is usually considered the gold standard, and ventilation perfusion pulmonary scan have shown good results in this field, but the first is costly and invasive, and both are not easily a nd rapidly available in all centers. Echocardiography can be helpful i n the diagnosis of pulmonary embolism; transthoracic echo in particula r is able to recognize indirect sins of the disease, due to acute pres sure right overload; it is also possible to evaluate pulmonary artery systolic pressure by continuous wave Doppler. Transthoracic echocardio graphy can be negative in cases of small pulmonary embolism, in which the pressure overload and therefore haemodynamic impairment is trivial . The sensitivity and specificity of transthoracic echo is low, but it s role in the diagnosis and management of pulmonary embolism may be im portant, because it can easily and rapidly show the presence and degre e of right ventricular pressure overload and therefore it can help in addressing therapy and prognosis. Transesophageal echo may directly de monstrate thrombotic masses in the main pulmonary arteries or, less of ten, floating intracavitary thrombi. In this field it is showing promi sing results. (C) 1998 Elsevier Science Ireland Ltd.