Saddle pulmonary embolus
Bilateral calf pain and swelling, worse on the left. SOB.
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A non-occlusive saddle thrombus is present in the main pulmonary artery trunk, which extends into the descending segmental and sub-segemental branches.
No evidence of right-heart strain.
4 case question available
This patient had previously been admitted and treated for a small bowel obstruction and was not provided with adequate DVT prophylaxis during his hospitalization. Subsequently, he re-presented to the hospital with bilateral calf pain, edema and shortness of breath. He was diagnosed with a bilateral DVT and a non-occlusive saddle pulmonary embolus.
Although saddle pulmonary embolisms only make up 3-6% of all PEs it is important to identify saddle pulmonary embolism as these patients are statistically more likely to require respiratory support and ventilation 1-2. Although previously thought to carry a higher mortality rate, it has been noted that saddle PEs do not carry a statistically higher rate of death, sitting at approximately 5%, comparable to PE at any anatomical location 3.
Case courtesy of Dr. Amer Alaref - TBHSC DI
- 1. Alkinj, B., Pannu, B., Apala, D., Kotecha, A., Kashyap, R., & Iyer, V. (2017). Saddle vs Nonsaddle Pulmonary Embolism: Clinical Presentation, Hemodynamics, Management, and Outcomes. Mayo Clinic Proceedings., 92(10), 1511-1518.
- 2. Ryu JH, Pellikka PA, Froehling DA, Peters SG, Aughenbaugh GL. Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome. Respir Med. 2007 Jul;101(7):1537-42.
- 3. Sardi A, Gluskin J, Guttentag A, Kotler MN, Braitman LE, Lippmann M Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med. 2011 Nov;39(11):2413-8.