Presentation
Acute onset chest pain and hypoxia.
Patient Data
Large intra-luminal filling defect (saddle thrombus) straddles the pulmonary artery bifurcation and extends into the main pulmonary arteries and through segmental and subsegmental branches of the upper and lower pulmonary lobar arteries in the bilateral lungs
Case Discussion
Given this patient's acute chest pain and hypoxia, the differential diagnoses included pulmonary embolism, pnuemothorax, and acute coronary syndrome. This patient's high pretest probability of pulmonary embolism prompted the use of CT pulmonary angiography which would reveal a large thrombo-embolus straddling along the bifurcation of the pulmonary artery with extension into the segmental and subsegmental branches. Saddle pulmonary emboli have the potential to completely obstruct the right and left pulmonary arteries causing right heart strain, hemodynamic instability, and eventually death. Prompt treatment is essential for patients with saddle pulmonary emboli.
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