Echocardiography in the Management of Pulmonary Embolism

Echocardiography in the Management of Pulmonary Embolism

Samuel Z. Goldhaber, MD

From Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

Echocardiography is not recommended as a routine imaging test to diagnose suspected pulmonary embolism. However, it is useful for identifying patients with pulmonary embolism who may have a poor prognosis. It can be used for rapid and accurate risk assessment. Moderate or severe right ventricular hypokinesis, persistent pulmonary hypertension, a patent foramen ovale, and free-floating right-heart thrombus are echocardiographic markers that identify patients at risk for death or recurrent thromboembolism. Such patients warrant consideration for thrombolysis or embolectomy. Serial imaging of right ventricular function can help physicians monitor the effect of treatment and judge whether the selected management strategy is successful. Further research will clarify and define more precisely the utility and limitations of echocardiography in the management of pulmonary embolism.

Article and Author Information

Acknowledgments: The author thanks the following echocardiographers, who provided useful critique with rapid turnaround time: Michèle A. Hamilton, MD (University of California, Los Angeles, Los Angeles, California); Richard T. Lee, MD (Brigham and Women's Hospital, Boston, Massachusetts); Sharon C. Reimold, MD (University of Texas Southwestern, Dallas, Texas); and Keith Comess, MD (Dartmouth Medical School, Hanover, New Hampshire).
Requests for Single Reprints: Samuel Z. Goldhaber, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, sgoldhaber{at}partners.org.