The unfortunate miss: a saddle pulmonary embolism

  • Authors

    • William Li SUNY Upstate Medical University
    • Marek Gruca
    • Bhaskara Madhira
    2017-05-09
    https://doi.org/10.14419/ijm.v5i1.7547
  • Pulmonary, Embolus, Thrombus, Thrombolysis, Echocardiogram.

  • Pulmonary embolism is a potentially life-threatening condition that requires prompt diagnosis and efficient management such as in the form of thrombolysis or surgical thrombectomy. Saddle pulmonary emboli occurring at the bifurcation of the pulmonary artery are especially dangerous as they put afflicted individuals at risk for sudden hemodynamic collapse. While CT Angiography at present is the current imaging modality of choice, times exist when they are contraindicated and V/Q scintigraphy is used as the choice alternative. We present a rare catastrophic case of a saddle pulmonary embolism in an individual with a low-probabilityinterpretation on V/Q scintigraphy despite a clear depiction of the thrombus on echocardiography.

  • References

    1. [1] Pruszcyk P, Pacho R, Ciurzynski M, Kurzyna M, Burakowska B, Tomkowski W (2003) Short term clinical outcome of acute saddle pulmonary embolism. Heart 89 (3), 335-336. https://doi.org/10.1136/heart.89.3.335.

      [2] Bettman, MA, Baginski, SG, White RD, Woodlard, PK, Abbara S, Atalay MK, Dorbala S, Haramati LB, HendelRc, Martin ET 3rd, Ryan T, Steiner RM (2012) ACR appropriateness criteria acute chest pain—suspected pulmonary embolism. Journal of Thoracic Imaging; 27(2), 28-31. https://doi.org/10.1097/RTI.0b013e31823efeb6.

      [3] Sostman, HD, Stein, PD, Gottschalk, A, Matta F, Hull R, Goodman L (2008) Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 246(3), 941-946. https://doi.org/10.1148/radiol.2463070270.

      [4] Kwak M, Kim W, Lee C, Seo DW, Sohn CH, Ahn S, Lim KS, Donnino MW (2013) The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism. The British Journal of Radiology 86 (1032). https://doi.org/10.1259/bjr.20130273.

      [5] Dresden, S, Mitchell, P, Rahimi, L, Leo M, Rubin-Smith J, Bibi S, White L, Langlois B, Sullivan A, Carmody K (2014) Right ventricular dilatation on bedside echocardiography performed by emergency physicians aids in the diagnosis of pulmonary embolism. Annals of Emergency Medicine 63(1), 16-24.https://doi.org/10.1016/j.annemergmed.2013.08.016.

      [6] Abdelaziz M, Wali S, Hamad M, Krayem A, Samman Y (2006) Pulmonary embolism: a diagnostic approach. Annals ofThoracic Medicine1(1), 31-40.https://doi.org/10.4103/1817-1737.25869.

      [7] Dauphine C, Omari B (2005) Pulmonaryembolectomy for acute massive pulmonary embolism. Annals of Thoracic Surgery 79(4), 1240-1244. https://doi.org/10.1016/j.athoracsur.2004.08.081.

      [8] Samoukovic G, Melas T, Varennes B (2010) the role of pulmonary embolectomy in the treatment of acute pulmonary embolism: a literature review from 1968 to 2008. Interactive CardioVascular Thoracic Surgery 11(3), 265-270. https://doi.org/10.1510/icvts.2009.228361.

      [9] Nama V, Siddiqui S, Balasubramanian R, Sarasam R, Shetty V (2016) Saddle pulmonary embolism: right ventricular strain an indicator for early surgical approach. Oxford Medical Case Reports 6, 130-134.https://doi.org/10.1093/omcr/omw045.

  • Downloads

  • How to Cite

    Li, W., Gruca, M., & Madhira, B. (2017). The unfortunate miss: a saddle pulmonary embolism. International Journal of Medicine, 5(1), 136-138. https://doi.org/10.14419/ijm.v5i1.7547