Saddle pulmonary embolus

Case contributed by Dr Sara Stephensen

Presentation

Bilateral calf pain and swelling, worse on the left. SOB.

Patient Data

Age: 55 years
Gender: Male
CT

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.

Case Discussion

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

 

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Case information

rID: 64353
Published: 24th Nov 2018
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included
Institution: Thunder Bay Regional Health Sciences Centre

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