Saddle pulmonary embolism


  • A 52 years old man
  • Presented with acute hemoptysis
  • Associated with dyspnoea and mild fever
  • History of major operation (total knee replacement) about 2 weeks ago
  • Clinically patient is tachypnoeic
  • Lungs crepitation at both lower zones
  • Chest radiograph showed no significant findings
CTPA in axial planes

CT pulmonary angiogram findings:

  • There is large thrombus seen that straddles the bifurcation of pulmonary trunk extending into the right and left pulmonary arteries (red arrows).
  • The thrombus is seen extending into superior and inferior segmental pulmonary arteries in both sides (red arrows).
  • Minimal contrast is seen within the peripheral of the arteries.
  • There is associated expansion of the arteries suggestive of its acute nature.
  • Consolidation involving the left lower lobe (yellow arrow).
  • Minimal left pleural effusion is seen (blue arrows).

Diagnosis: Acute saddle pulmonary embolism


  • A pulmonary embolism is an obstruction of the pulmonary artery or 1 of its branches by a thrombus, tumor, air, or fat matter.
  • A saddle pulmonary embolism is a thromboembolus that occurs at the bifurcation of the main pulmonary artery.
  • It represents a potentially large, unstable clot associated with sudden hemodynamic collapse.
  • Untreated pulmonary embolisms have a high mortality rate
Author: radhianahassan