Sumario Vol.43 - Nº 3 Julio-Septiembre 2014 Imprimir sólo la columna central

Pulmonary Artery Thrombus Visualization
by Transthoracic Echocardiography

Gustavo Vega, Eduardo Giner, Augusto Ortego

Hospital del Carmen. (5501) Godoy Cruz, Mendoza, Argentina.
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Recibido 27-Mayo-2014 – ACEPTADO después de revisión 08-JULIO-2014.
The authors declare not having conflicts of interest
 
Rev Fed Arg Cardiol. 2014; 43(3): 159-160

We present the echocardiographic image and its tomographic correlation of a 67-year-old male, with history of consumptive syndrome and recent diagnosis of deep venous thrombosis. The patient was admitted in our hospital because of sudden dyspnea. Before the high suspicion of acute pulmonary thromboembolism, transthoracic echo (TTE) was performed, which verified severe dilatation of the right chambers, interventricular septum flattening, dyskinesia of the right ventricular free wall and severe tricuspid regurgitation with pulmonary systolic pressure of 55 mmHg.

In the suprasternal windows, dilatation of the pulmonary artery and mobile echo-dense image were evident, within the right branch, compatible with a large thrombus (Figure. Arrows in the upper panel). This image was corroborated and confirmed by chest helical computed tomographic angiography with contrast. (Figure. Arrows in the lower panel of the image).

Subsequently, the diagnosis of a tumor mass in the head of the pancreas with multiple liver metastasis was made. When discharged, the patient continued with anticoagulation, home oxygen and palliative oncological treatment.

 

DISCUSSION
In the clinical case presented, the signs, symptoms and history of the patient posed the diagnosis of pulmonary thromboembolism (PTE). The echocardiographic alterations of the right chambers such as dilatation, dyskinesia of the free wall, interventricular wall septum, and increase in pulmonary systolic pressure (PSP), supported this diagnosis [1]. The direct observation of thrombi in the pulmonary artery or its main branches, has been rarely reported by transthoracic echo, although it is frequent to observe them in transesophageal echocardiography (TEE), so this is the technique of choice in severely ill patients [2], in whom the diagnosis of PTE is suspected. Although currently it is accepted that the best technique to confirm or rule out PTE is chest helical computed tomography angiography with contrast [3], echocardiography, whether TTE or TEE, allows to identify patients in high risk that would benefit with thrombolytic treatment [4].

 

REFERENCES

  1. Braunwald´sHeartdisease. 9th ed.Chapter 77, Pulmonaryembolism, page 1708.In Braunwald'sHeartDisease: a Textbook of Cardiovascular Medicine. Single Volume: 978-1-4377-0398-6. Copyright © 2012, by Saunders, animprint of Elsevier Inc. International Edition: 978-0-8089-2436-4.
  2. Cerel A, Burger AJ. The diagnosis of a pulmonaryarterythrombusbytransesophagealechocardiography. Chest1993; 103 (3): 944-5.
  3. Goldhaber SZ: Multislicecomputedtomographyforpulmonaryembolism a technologicalmarvel. N Engl J Med2005; 352 (17): 1812-4.
  4. Kopecna D, Briongos S, Castillo H, et al. PROTECT investigators. Interobserverreliability of echocardiographyforprognostication of normotensivepatientswithpulmonaryembolism.CardiovascUltrasound2014; 12: 29. doi: 10.1186/1476-7120-12-29.


Publication: September 2014



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