Submassive pulmonary embolism

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
  • biomarker elevations
    • brain natiuretic peptide (BNP) > 90 pg/mL or pro-BNP >500 pg/mL
  • characteristic electrocardiographic abnormalities
    • right bundle branch block
    • anteroseptal ST-T wave abnormalities

Differential diagnosis