Last Updated on August 19, 2026
Risk Factors
• History of thromboembolism / Inherited thrombophilia • e.g. prolonged bedridden in hospital, traction for lower limb fracture especially pelvic, lower limb surgery
•
Immobility
• Therefore, if suspect PE, also ask about any recent Hx of hospitalization
•
Surgery (Post-operation)
• Malignancy
• Active inflammation
• Pregnancy / COCP / HRT
Investigations
Blood
• D-Dimer
Bedside USG
×e.g. in ED setting
: Cardiac USG for massive acute pulmonary embolism
e.g. in ED setting
Signs
May not be detected in small PE load which does not produce significant right heart strain approaching / exceeding size of left ventricle Normally right ventricular apex is sharp • less than 5 mm; measured in subcostal 4-chamber view • Paradoxical bowing of septum into left ventricle hypomotility of RV free wall with relative apical sparing Pulmonary embolism
–
Large
–
Thin
• Normal RV thickness but enlarged RV suggest acute RV pressure overload
–
D-shaped left ventricle
• Normally interventricular septum is round during systole & diastole as LV pressure is always higher than RV pressure
—–
•
McConnel sign
—–
Relevant posts:
– Cardiac ultrasound in emergency
Q&A
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References / Further Reading
- Guide to essentials in emergency medicine (2nd ed, Shirley Ooi et al.): cardiac ultrasound for massive
pulmonary embolism
×Pulmonary embolism
Pulmonary embolism
- Oxford Handbook of Clinical Medicine, 10th ED