Cas du 03/04/2015: Acute SOB

Presentation: A patient presented with acute shortness of breath. The following echo loop was obtained.

#1: What is the diagnosis?


#2: What is your recommended therapy?





















Explanation: The diagnosis is an acute pulmonary embolus. The embolus in the right pulmonary artery is adhered to the right pulmonary artery wall. The pulmonary artery does not appear to be significantly dilated. A PAC was even floated into the right pulmonary artery so either both sides are equally obstructed or the obstruction in the right pulmonary artery is not severe.

The recommended therapy is conservative with heparin anticoagulation/TPA. Directly delivered TPA is indicated in compromised patients. Operative intervention or mechanical percutaneous pulmonary embolectomy is indicated in massive pulmonary embolism where the oxygenation and/or cardiovascular status is unstable and/or life-threatening. Acute right ventricular dilation is a poor prognostic sign and does not respond to pulmonary vasodilators.

Echocardiography is useful for initial assessment of the right ventricular function, pulmonary artery pressure, the presence of a shunt, pulmonary regurgitation, tricuspid regurgitation, thrombus location, and global cardiac function. Serial echocardiographic assessments can help determine if the therapy is effective.