Saddle pulmonary embolus
Shortness of breath. ECG shows 'RSR' pattern and hypoxic requiring oxygen support. No chest pain. New atrial fibrillation and elevated serum troponin. Investigations reviewed by cardiology, suggested investigation for pulmonary embolism.
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A large saddle embolus straddles the pulmonary trunk bifurcation. Extensive pulmonary emboli are also noted in the right and left second and third generation pulmonary arteries. These are more prominent on the left side.
No evidence of interventricular septal deviation or pulmonary hypertension, however there is generalised cardiomegaly (CTR 16:25).
There are ground-glass changes in the inferior lingular segment of the left lung which may represent oedema secondary to emboli.
Saddle emboli, given their central and obstructive nature, are associated with a high clot load and can give rise to right heart strain. Straightening of the interventricular septum and, in more severe cases, reflux of contrast into the inferior vena cava are both surrogate signs of this.