[Massive pulmonary embolism--echocardiographic diagnosis and thrombolytic therapy]

Thrombolysis is widely accepted as the treatment of choice for acute massive life-threatening pulmonary embolism. Several trials have shown that thrombolytic treatment has reduced morbidity and mortality in this condition, compared to heparin therapy. Rapid diagnosis and treatment start is mandatory for improving the prognosis. Clinical presentation, ECG, arterial blood gas analysis and D-dimer are non-specific tests. Additional tests like ventilation/perfusion lung scan, spiral-computed tomography or pulmonary angiography are needed. In an emergency situation a non-invasive and bedside technique is preferred, and several studies have demonstrated the accuracy of echocardiography in pulmonary embolism. Acute right ventricular overload is indicated by different echocardiographic findings. Three cases with the echocardiographic method as the initial technique for the diagnosis of massive pulmonary embolism are described as well as the treatment consequence and practical administration of thrombolysis. Our patients had presenting features suggestive of massive pulmonary embolism, a clinical situation where an echocardiographic evaluation is appropriate. All presented with typical echocardiographic features. Thrombolytic treatment was initiated immediately after echocardiographic diagnosis. Different thrombolytic regimens were used. Echocardiography may be used as the initial imaging technique for the diagnosis of massive pulmonary embolism. The advantages are obvious, and thrombolytic treatment can be initiated without delay.