Three-dimensional transesophageal echocardiography: diagnosing intraoperative pulmonary artery thrombus

The presented case report is of interest in the accumulation of clinical experience and emphasizes the importance of careful identification of the causes of cardio-pulmonary failure [1]. Acute pulmonary artery thrombus is the third most common reason for hospital mortality in patients with acquired heart defects [2]. Symptoms of pulmonary thromboembolism are non-specific and typical of many other cardiac and pulmonary diseases. Pulmonary artery embolism is the most frequently misdiagnosed disease. Deterioration of the patient's condition with pulmonary embolism occurs quickly. Therefore, it is very important to have the opportunity and the method to detect this complication rapidly and accurately. We have experience in treating patients with pulmonary embolism as the underlying disease and as a complication. The primary diagnosis is made on the clinical status of the patient and two-dimensional transthoracic echocardiography. In adult patients it is not always possible to visualize the pulmonary artery clearly. Non-specific two-dimensional echocardiographic signs of pulmonary artery thrombus, such as echo dense, circular or linear mass in more than one view of the pulmonary artery, may be just artifacts. That is why transesophageal echocardiography is necessary to confirm pulmonary artery thrombus. Three-dimensional transesophageal echocardiography significantly increases the ability to diagnose this disease. Three-dimensional transesophageal echocardiography determines thrombus in the trunk and main branches of the pulmonary artery, but visualization of the distal pulmonary bed is impossible. Computed tomography and magnetic resonance (MR) imaging provide greater diagnostic ability to identify massive or non-massive pulmonary embolism, allowing identification of not only the blood clots and the involvement in the pathological process of the lung tissue, but also in making a differential diagnosis of other lung diseases [3]. Despite the advantages of computed tomography and MR imaging, intraoperative three-dimensional transesophageal echocardiography actually should be used in adult patients with a poor transthoracic ultrasonic window and/or controversial two-dimensional echocardiographic data.