Role of Echocardiography in a Patient With Suspected Acute Pulmonary Embolism

A Case Report

Julio Miranda-Bacallado; María Manuela Izquierdo-Gómez; Javier García-Niebla; Juan José Jiménez; José Luis Iribarren; Ignacio Laynez-Cerdeña; Juan Lacalzada-Almeida

Disclosures

J Med Case Reports. 2019;13(37) 

In This Article

Background

Approximately half of pulmonary embolism (PE) cases are diagnosed in an emergency context.[1–3] The classic symptoms of PE are absent in intensive care unit (ICU) patients who are under sedation and on mechanical ventilation.[4] In this scenario, after the development of sudden, severe hypotension, PE must be considered and included as a differential diagnosis according to the cause of admission.[5] Our patient was admitted to the ICU with community-acquired pneumonia and was under sedation and mechanical ventilation and suddenly went into shock. In our patient, an adequate diagnosis with transthoracic echocardiography (TTE) was unachievable because of a poor echocardiographic window. Transesophageal echocardiography (TEE) played a pivotal role in our patient's case, helping with the differential diagnosis of the cause of shock and resulting in a diagnosis of PE as the most prevalent etiology.[6] The robust echocardiographic findings in this case raised the suspicion of PE, avoiding an unnecessary transfer of the patient for other complementary diagnostic tests and justifying the initiation of specific therapy without delay.

In a hemodynamically unstable patient, the mobilization of the patient to perform major complementary tests is difficult to achieve. In this situation, an echocardiographic assessment was available and could be performed, and it played a fundamental role in the diagnosis.

The combined use of TTE and TEE, due to the poor transthoracic window in our patient, ruled out the most common causes of shock: pericardial tamponade, acute valvular dysfunction, severe global or regional left ventricular (LV) dysfunction, aortic dissection, or hypovolemia. The echocardiographic findings of a severely dilated and dysfunctional right ventricle (RV) were confirmed, and focus was placed on a suspected diagnosis of PE. This allowed an early intensive treatment with a favorable outcome for our patient. Knowledge of the characteristic PE echocardiographic findings allowed the diagnosis to be made.

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