Saddle pulmonary embolism

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

A known case of cancer pancreas on chemotherapy under regular follow-up

Patient Data

Age: 65 years
Gender: Female
CT

Incidentally noted large intra-luminal filling defect (saddle thrombus) straddles the pulmonary artery trunk bifurcation extending into the main right and left pulmonary arteries as well as also along the anterior and posterior segmental and subsegmental branches of the upper and lower pulmonary lobar arteries partially occluding their lumens. 

Liver shows no significant time interval changes regarding the previously noted Pneumobilia and mild to moderate intra and extrahepatic biliary dilatation and mild progression of CBD dilation and abrupt cut of it distally at the pancreatic head suggestive of underlying pancreatic head isodense lesion.

Pancreas showing mild atrophic changes involving body and tail with a progression of pancreatic ductal dilatation with an abrupt cutoff to it at the pancreatic head.

CT

Follow up study after about 1 year

Total resolution of the previously noted bilateral pulmonary artery embolisms.

Case Discussion

This case known case of pancreatic cancer under regular follow up imaging came as an outpatient and underwent to routine pancreatic protocol CT examination.

The incidentally found large saddle thromboembolic pulmonary thrombus was discovered at the time of examination, and the patient was referred for an urgent casualty consultation because this is a critical finding and likely hemodynamically significant, and she was admitted to the hospital for treatment. The patient made a complete recovery following appropriate resuscitation and thrombolysis treatment and comes again for regular follow up. 

Saddle pulmonary embolism is defined as a visible thrombo-embolus straddling the bifurcation of the main pulmonary artery trunk.

The diagnosis of saddle pulmonary embolism causes clinical alarm because it signals an unstable, large clot burden in the pulmonary artery trunk, and the possibility of sudden hemodynamic collapse.

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Case information

rID: 55992
Case created: 4th Oct 2017
Last edited: 25th Oct 2017
Systems: Vascular, Chest
Inclusion in quiz mode: Included

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