Presentation
Coughing, chest pain and shortness of breath for 3 days Diabetic and hypertensive
Patient Data
Filling defect straddling the bifurcation of the pulmonary trunk, with extension into the bilateral main pulmonary arteries. Further extension into all proximal lobar branches except the right lower lobe where the defects are peripherally located.
Dilated pulmonary trunk measuring 32 mm.
No pulmonary consolidation, nodules or masses.
Incidental large multinodular left thyroid lobe with moderate mass effect on the trachea. Further evaluation with USS recommended.
Incidental lobulated cystic pancreatic tail mass concerning for a serous cystic pancreatic neoplasm.
Case Discussion
Saddle pulmonary embolism is a visible thromboembolus straddling the bifurcation of the main pulmonary artery trunk 1. It signals an unstable, large clot burden and the possibility of sudden hemodynamic collapse. There however have been reports of incidental diagnosis in asymptomatic patients 2. There is variability in mortality from pulmonary embolism, and prognostic stratification has been adopted by various clinical association guideline committees including the European Society of Cardiology among others, based on evidence showing higher mortality in patients with hypotension and worse outcomes for patients with RV disease 3.
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