EchoBridgeMD Pearl #31: How to Measure RV Free Wall Thickness
Accurate measurement of right ventricular free wall thickness (RVFWT) requires careful image optimization.
Decrease the imaging depth and position the RV free wall near the center of the screen, with the focal zone at the level of the wall. Because ultrasound provides superior spatial resolution in the axial plane, orient the free wall horizontally so that the calipers measure perpendicular to the wall.
Measure RVFWT at end-diastole, when the RV is largest and the relaxed free wall is thinnest. In the subxiphoid long-axis view, measure just apical to the tricuspid annulus, approximately at the level where the tip of the anterior tricuspid leaflet would open in diastole.
Finally, be careful to exclude trabeculations, papillary muscles, and epicardial fat from the measurement.
At the bedside: An RV free wall >5 mm suggests RV hypertrophy and can help distinguish chronic RV pressure overload from an acute process such as pulmonary embolism. A few millimeters can change that interpretation—so optimizing the image before placing the calipers matters.
⠀
⠀
📖 Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med. 2023.
⠀
⠀
⠀
🔗 Free subscription — receive future EchoBridgeMD educational content by email:
Comments