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Scientific letters
Short term clinical outcome of acute saddle pulmonary embolism
  1. P Pruszczyk1,
  2. R Pacho2,
  3. M Ciurzynski3,
  4. M Kurzyna4,
  5. B Burakowska4,
  6. W Tomkowski4,
  7. A Bochowicz1,
  8. A Torbicki4
  1. 1Department of Internal Medicine and Hypertension , The Medical University of Warsaw, Warsaw, Poland
  2. 2Department of Radiology, The Medical University of Warsaw
  3. 3Department of Internal Medicine, The Medical University of Warsaw
  4. 4Department of Chest Medicine, Institute of Lung Diseases and Tuberculosis, Warsaw, Poland
  1. Correspondence to:
    Dr Piotr Pruszczyk, Department of Internal Medicine and Hypertension, Medical University of Warsaw, Banacha 1a, O2-097 Warsaw, Poland;
    piotr.pruszczyk{at}amwaw.edu.pl

https://doi.org/10.1136/heart.89.3.335

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    Wider application of spiral computed tomography (CT) not only improves diagnosis of acute pulmonary embolism (PE) (fig 1), but also allows for non-invasive visualisation of saddle thromboemboli at the level of the bifurcation of the pulmonary trunk and extending into the main right and the main left pulmonary arteries.1–3 Such proximal thrombus may be regarded as unstable, “in-transit” embolus, which can fragment spontaneously or secondary to treatment and obstruct multiple, distal pulmonary arteries. It remains unclear whether this may further increase haemodynamic compromise. Also, it is unknown whether saddle PE requires modification of clinical management. We tried to evaluate if saddle thromboembolus affected two week outcome of patients with acute PE.

    Figure 1

    Spiral CT scan showing large saddle pulmonary thromboembolus in a 46 year old man successfully treated with anticoagulation.

    METHODS

    Saddle PE was documented with spiral CT in 17 patients (10 men, 7 women, mean (SD) age 66 (11) years) out of 289 consecutive patients with tomographically diagnosed PE (5.2%). The saddle PE (S-PE) group was compared to 44 consecutive patients (17 men, 27 women, aged 66 (13) years with central, defined as at least lobar, non-saddle PE (NS-PE) proven by spiral CT. At the time of the diagnosis all patients underwent transthoracic echocardiography for the assessment of right …

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