Submassive pulmonary embolism

Last revised by Dr David Carroll on 19 Feb 2021

A submassive pulmonary embolism refers to an acute pulmonary embolism with evidence of myocardial necrosis or right ventricular dysfunction in the absence of systemic hypotension. An elevation in troponin I or T provides evidence of myocardial necrosis. Right ventricular dysfunction is defined by the presence of any of the following: 

  • echocardiographic evidence of right ventricular dilation or systolic dysfunction
  • an RV/LV diameter ratio >0.9 on CT 4
  • biomarker elevations
    • brain natriuretic peptide (BNP) > 90 pg/mL or pro-BNP >500 pg/mL
  • characteristic electrocardiographic abnormalities
    • right bundle branch block (complete or incomplete)
    • anteroseptal ST segment deviation
    • anteroseptal T wave inversion

Differential diagnosis

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Cases and figures

  • Case 1: submassive PE with RV dilation
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  • Case 2: submassive PE
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