ABSTRACT
Acute pulmonary embolism (PE) remains one of the major causes of in-hospital mortality. Suspected high-risk PE (in patients with shock or hypotension) is an immediately lifethreatening situation, and according to current guidelines requires urgent diagnostic work-up1 to justify life-saving primary thrombolysis or pulmonary embolectomy. If immediate computed tomography angiography (CTA) is not feasible, transthoracic echocardiography (TTE) is an acceptable alternative. It can provide evidence of acute pulmonary hypertension and right ventricular (RV) dysfunction. In a highly unstable patient with suspected PE, echocardiographic evidence of RV dysfunction is sufficient to prompt immediate reperfusion without further testing. However, visualization of pulmonary thromboemboli, preferably by multislice computed tomography (MSCT), is indicated whenever possible.
