الفهرس 
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Abstract
Acute pulmonary thromboembolism (PTE) is a common clinical problem that is associated with substantial morbidity & mortality. Estimates of PTE mortality & prediction of PTE trends have varied widely.
There are at least 600,000 estimated cases of newly diagnosed PTE and more than 50,000 related deaths in the United States each year (Wood KE, 2014).
The overall 3-month mortality rate of all patients who present with PTE is reported to be about (15%) and the reported mortality rate for those in shock is nearly (50%). This fatality rate for PTE exceeds the mortality rate for acute myocardial infarction. In spite of increasing knowledge about PTE and imaging technology, the antemortem diagnosis of fatal PTE has not changed appreciably over the last 40 years and remains fixed at approximately (30 %) (Lilienfeld DE et al, 2012).
Acute coronary syndromes, acute aortic syndromes and acute PTE are the three major disease entities in patients presenting with chest pain in the emergency room. The problem is the similarity in clinical presentation between acute coronary syndromes and PTE. The most common symptoms in PTE include dyspnea in (80%) and chest discomfort in (65%) of patients. However, these symptoms are non-specific in the differentiation of PTE and acute coronary syndromes (Simonneau G et al, 2013).
Also, features of PTE on physical examination are non-discriminatory in the differentiation. Given the significant overlap of signs and symptoms between PTE and acute coronary syndromes. Clinicians, especially cardiologists, should be familiar with this disease entity. PTE should be considered as one of the possible causes. Presently Transthoracic Echocardiography (TTE) is a non-invasive modality providing rapid results at the bedside. This modality is one of the most useful tests in aiding diagnosis and risk stratification in patients with PTE (Konstantinides S, 2015).
Acute pulmonary thromboembolism (PTE) is a common problem. In the emergency room, a substantial number of patients with chest discomfort have had an acute PTE. Transthoracic echocardiography (TTE) is a non-invasive modality providing rapid results at the bedside. As well as being non-invasive modality, TTE avoids the contrast and radiation hazards of chest CT or conventional angiography (Rahimtoola A, Bergin JD, 2015).
Echocardiography is an attractive imaging modality to diagnose PTE. TTE allows visualization of the aorta and the LV to evaluate for other etiologies of chest pain. Besides giving important diagnostic information, TTE can aid prediction of prognosis. Presence of RV dilatation and dysfunction is a poor prognostic sign and is the indicator for thrombolytic therapy (Goldhaber SZ, Elliott CG, 2013).
There are numerous risk factors for pulmonary embolism but we found that history of DVT has a high risk & most likely for precipitating PE in the addition to history of recent major abdominal, pelvic and orthopedic operation is a high risk factor for PE.
The presentation vary from patient to another, all of them presented with dyspnea, 18 patients (45) % with chest pain, 8 patients (20%) were hypotensive & only 4 patients (10%) presented with hemoptysis.
Echocardiography in our study revealed the following findings:
35 patients (87.5 %) have Tricuspid regurge, 30 patients (75%) have dilated Right ventricle, 30 patients (75%) have echocardiographic finding of pulmonary hypertension, 10 patients (25%) have McConnell sign and only 2 patients (5%) show Right Ventricle thrombosis.
We found that thrombus in main pulmonary trunk or Left pulmonary artery has a direct proportion with high risk patients.
According to our results; Echocardiograpy is an excellent bedside test non invasive test for rapid diagnosis of pulmonary embolism & determining the degree of the risk category (high or low risk patients).
Conclusion:
Our study revealed that echocardiography is an important imaging tool for diagnosis of pulmonary embolism by detecting the following findings such as Tricuspid Regurge, Right ventricle dilatation & dysfunction, Pulmonary hypertension, McConnell’s sign and Right ventricle thrombosis.
We found that thrombus in main pulmonary trunk or Left pulmonary artery has a direct proportion with high risk patients.
According to our results; Echocardiography is an excellent bedside test non invasive test for rapid diagnosis of pulmonary embolism & determining the degree of the risk category (high or low risk patients).
Recommendations:
1. Echocardiography is an important imaging tool for diagnosis of pulmonary embolism in emergency department.
2. Echocardiography is not a conclusive tool for diagnosis of pulmonary embolism but it is a highly suggestive for diagnosis of pulmonary embolism.
3. CT pulmonary angiography is still the gold standard test for diagnosis of pulmonary embolism.
4. The study revealed that the thrombus in main pulmonary trunk or Left pulmonary artery has a direct proportion with high risk patients.
5. The following findings of Echocardiography such as Tricuspid Regurge, Right ventricle dilatation & dysfunction, pulmonary hypertension, McConnell sign and Right ventricle thrombosis are indicators for diagnosis of pulmonary embolism.
Limitations:
1. Small number of patients in the study.
2.Short follow up period.