Skip to main content
Journal cover image

Case report: optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography.

Publication ,  Journal Article
Izrailtyan, I; Clark, J; Swaminathan, M; Podgoreanu, MV; Mackensen, B; Davis, RD; Mathew, JP
Published in: Can J Anaesth
July 2006

PURPOSE: Perioperative pulmonary embolism (PE) is associated with significant morbidity and mortality. Intraoperatively, the clinical management of patients with PE can be enhanced by the use of transesophageal echocardiography (TEE) to visualize emboli, assess pulmonary artery (PA) anatomy, and monitor the function of the right ventricle. However, the sensitivity of intraoperative TEE to detect thromboemboli is reported to be below 50%. In this report, we describe the use of contrast-enhanced TEE (CE-TEE) to improve the visualization of PE. CLINICAL FEATURES: A 44-yr-old female with chronic thrombo-embolic pulmonary hypertension was scheduled for pulmonary thromboendarterectomy. The precardiopulmonary bypass TEE exam demonstrated signs of PA obstruction and right ventricle dysfunction, but the borders of the thrombus in the right PA were only minimally visualized. Perflutren lipid microspheres, composed of octafluoropropane encapsulated in an outer lipid shell, were injected as a 0.3 mL iv bolus, while visualizing the right PA with harmonic ultrasound imaging. The CE-TEE image clearly visualized a large mobile thrombus along with a distinct pattern consistent with pulmonary flow obstruction. The postcardiopulmonary bypass CE-TEE confirmed thrombus evacuation and absence of PA flow abnormalities. CONCLUSION: Contrast-enhanced-TEE may decrease operator dependency and increase the sensitivity necessary to detect central, surgically accessible PE.

Duke Scholars

Published In

Can J Anaesth

DOI

ISSN

0832-610X

Publication Date

July 2006

Volume

53

Issue

7

Start / End Page

711 / 715

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Pulmonary Embolism
  • Pulmonary Artery
  • Monitoring, Intraoperative
  • Microspheres
  • Image Enhancement
  • Humans
  • Heart Ventricles
  • Fluorocarbons
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Izrailtyan, I., Clark, J., Swaminathan, M., Podgoreanu, M. V., Mackensen, B., Davis, R. D., & Mathew, J. P. (2006). Case report: optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography. Can J Anaesth, 53(7), 711–715. https://doi.org/10.1007/BF03021630
Izrailtyan, Igor, Jeffrey Clark, Madhav Swaminathan, Mihai V. Podgoreanu, Burkhard Mackensen, R Duane Davis, and Joseph P. Mathew. “Case report: optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography.Can J Anaesth 53, no. 7 (July 2006): 711–15. https://doi.org/10.1007/BF03021630.
Izrailtyan I, Clark J, Swaminathan M, Podgoreanu MV, Mackensen B, Davis RD, et al. Case report: optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography. Can J Anaesth. 2006 Jul;53(7):711–5.
Izrailtyan, Igor, et al. “Case report: optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography.Can J Anaesth, vol. 53, no. 7, July 2006, pp. 711–15. Pubmed, doi:10.1007/BF03021630.
Izrailtyan I, Clark J, Swaminathan M, Podgoreanu MV, Mackensen B, Davis RD, Mathew JP. Case report: optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography. Can J Anaesth. 2006 Jul;53(7):711–715.
Journal cover image

Published In

Can J Anaesth

DOI

ISSN

0832-610X

Publication Date

July 2006

Volume

53

Issue

7

Start / End Page

711 / 715

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Pulmonary Embolism
  • Pulmonary Artery
  • Monitoring, Intraoperative
  • Microspheres
  • Image Enhancement
  • Humans
  • Heart Ventricles
  • Fluorocarbons
  • Female