Chapter 7: Echocardiography in acute pulmonary embolism

The hemodynamic consequences of acute pulmonary embolism (PE) can be detected by echocardiography.
Normal right ventricular morphology and function make acute PE highly unlikely as a cause of hemodynamic instability.
Echocardiographic signs of right ventricular overload (McConnell’s sign and 60/60 sign) are indirect signs suggestive of intermediate-or high-risk acute PE, but could also result from other causes.
Thrombi in the pulmonary artery and the right side of the heart (direct signs of PE) are rarely detected by transthoracic echocardiography, but nevertheless indicate high mortality risk.
Transesophageal echocardiography can frequently detect thrombi in the proximal parts of the pulmonary arteries in patients with significant acute PE.
Echocardiographic signs of right ventricular dysfunction indicate worse prognosis in normotensive acute PE patients.
Patent foramen ovale is associated with worse prognosis in patients with acute PE.
Ultrasonographic detection of deep venous thrombosis supports the diagnosis of PE in a patient with clinically suspected acute PE.

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