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