Echocardiographic Predictors of Pulmonary Embolism in Patients Referred for Helical CT

Lodato, Joseph A.; Ward, R. Parker; Lang, Roberto M.

doi:10.1111/j.1540-8175.2008.00665.x

Cited by 57 publications

(41 citation statements)

References 13 publications

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“…7 More recently, Lodato et al reported the right-and left-ventricular end-diastolic dimension as the most accurate echocardiographic predictor of pulmonary embolism in patients referred for helical CT, but found the McConnell sign to be most specific (96%). 8 This finding resolved in our patient after thrombolytic therapy. Unfortunately, our patient developed an unexpected complication of his initial diagnosis.…”

Section: Discussionsupporting

confidence: 56%

Thrombolytic Therapy in a Patient With Suspected Pulmonary Embolism Despite a Negative Computed Tomography Pulmonary Angiogram

2011

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We report a case of a 62-year-old male who presented to our intensive care unit with hypoxemia 6 hours after retinal surgery. He had a negative computed tomography (CT) pulmonary angiogram, but an emergency echocardiogram revealed the McConnell sign. He was thrombolysed and had rapid improvement in oxygenation and hemodynamics. Thrombolysis in hemodynamically unstable pulmonary embolism is not controversial, but most algorithms require confirmation of the diagnosis. Our patient had a negative CT pulmonary angiogram but was thrombolysed based on the clinical picture. Autopsy confirmed the diagnosis of multiple pulmonary emboli and unexpectedly discovered a patent foramen ovale that explained paradoxical embolism to the brain.

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Section: Discussionsupporting

confidence: 56%

Thrombolytic Therapy in a Patient With Suspected Pulmonary Embolism Despite a Negative Computed Tomography Pulmonary Angiogram

2011

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“…At present, the evaluation of patients with suspected PE consists of echocardiography and CTPA [3]. Echocardiography is both a rapid and accurate risk-assessment tool that is useful in identifying the PE patients who have a poor prognosis [3,21,22]. Its ability to visualize pulmonary arterial clots that are not very large or centrally located is, however, quite limited [21].…”

Section: Discussionmentioning

confidence: 99%

The association between the embolic load and atrial size in acute pulmonary embolism

Aviram

Steinvil

Berliner

et al. 2011

Journal of Thrombosis and Haemostasis

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Summary. Background: Early identification by computed tomography pulmonary angiography (CTPA) of patients with acute pulmonary embolism (PE) who have signs associated with a high embolic burden would be highly desirable. Objectives: To investigate whether an increased obstruction of the pulmonary vasculature is associated with reduced left atrial (LA) and increased right atrial (RA) areas. Methods: We retrospectively analyzed a consecutive series of CTPA studies of 137 patients with acute PE and 38 controls without PE between October 2004 and March 2006. Left and right atrial areas and longitudinal and short axis diameters were measured and correlated with the pulmonary arterial obstruction index (PAOI) divided into tertiles (obstruction of < 12.5%, 12.5%-42.5% and ‡ 42.5%). Results: There was a significant negative age-and gender-adjusted correlation between the PAOI and LA measurements, particularly the LA area (r = )0.259) and the LA short axis diameter (r = )0.331). All RA measurements had positive correlations (RA area, r = 0.279; RA short axis diameter, r = 0.313). The LA/RA area ratio correlated negatively with the PAOI (r = )0.447). All above-mentioned correlations had P < 0.002. All the LA measurements were the largest in the controls and gradually decreased with higher PAOIs. A receiver operating characteristic curve analysis demonstrated that the RV/LV diameter, LA/RA area and LA/RA short axis diameter ratios had comparable discriminative ability for higher PAOI tertiles. Conclusions: The higher the clot load in the pulmonary arteries, the smaller the LA area and the larger the RA area. Atrial area measurements by CTPA may serve as a real-time parameter in assessing the severity of PE upon diagnosis.

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“…11,12 Studies performed on critically ill patients in the ICU setting have demonstrated the accuracy of transthoracic echocardiography in the diagnosis of acute pulmonary embolism and validated the right/left ventricle end-diastolic area ratio (threshold value >0.6) and the paradoxical septum (classically evaluated in the long-and short-axis views, respectively) as sonographic signs of acute right ventricle overload. [14][15][16] It can be speculated that a more detailed echocardiographic study would have shown these signs in our patient, but a comprehensive study would have needed short-axis and four-chamber views, subcostal and parasternal scans, and even measurements of end-diastolic ventricle areas from an apical four-chamber view. Of course, this is rarely possible in the setting of cardiac arrest, when focused ultrasound is performed during the brief intervals of resuscitative maneuvers.…”

Section: Discussionmentioning

confidence: 88%

Sonographic diagnosis of pulmonary embolism with cardiac arrest without major dilation of the right ventricle or direct sign of lower limb venous thrombosis

Volpicelli

Mussa

Frascisco

2011

J of Clinical Ultrasound

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Bedside focused echocardiography diagnosis of massive pulmonary embolism during cardiac arrest is mainly based on the detection of a dilated right ventricle, while the lack of compressibility of a deep vein of the lower limbs confirms diagnosis in doubtful cases. We describe a case of unusual sonographic signs in a young woman with cardiac arrest due to massive pulmonary embolism showing spontaneous blood echogenicity in the inferior vena cava ("sludge sign") and nonmodulated ("flat") Doppler waveform in the left lower limb veins, suggesting isolated iliac vein thrombosis.

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Echocardiographic Predictors of Pulmonary Embolism in Patients Referred for Helical CT

Abstract: RV/LV EDD ratio > 0.7 has good accuracy for the diagnosis of acute PE. RV/LV area ratio > 0.7 and McConnell sign are specific but not sensitive indicators of acute pulmonary embolism. The presence of these findings should prompt further diagnostic testing for PE.

Cited by 57 publications

References 13 publications

Thrombolytic Therapy in a Patient With Suspected Pulmonary Embolism Despite a Negative Computed Tomography Pulmonary Angiogram

Thrombolytic Therapy in a Patient With Suspected Pulmonary Embolism Despite a Negative Computed Tomography Pulmonary Angiogram

The association between the embolic load and atrial size in acute pulmonary embolism

Sonographic diagnosis of pulmonary embolism with cardiac arrest without major dilation of the right ventricle or direct sign of lower limb venous thrombosis

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