echo in venous thrombo
Evaluation of the critically ill patient with suspected or confirmed pulmonary embolism remains a challenging clinical quandary. Critical care echo (CCE) can be a valuable bedside adjunct in patients who are too sick to be transported or continue to deteriorate, despite escalating intensive therapy. Whether it is used as a diagnostic adjunct, in hemodynamic evaluation, or prognostically to evaluate risk of deterioration, CCE can provide critical insights in a patient with severe cardiorespiratory and/or hemodynamic deterioration. CCE may also unveil potential confounders such as acute valvular regurgitation and biventricular failure.
Characteristic findings such as inter-ventricular septal flattening, RV dilatation and poor RV systolic movement can all signify an acute RV process, which may occur in the setting of acute pulmonary embolism. In fact, detection of RV dysfunction in the patient with confirmed pulmonary embolism is associated with a significantly increased in-hospital morbidity and mortality (1,2). CCE plays a critical role in risk assessment and guiding treatment decisions in patients who are severely hemodynamically compromised (3). Despite the appeal, CCE is not advised as a routine procedure in hemodynamically stable patients with confirmed pulmonary embolism (3).