Pulmonary Artery Thrombus Visible on Transthoracic Echocardiography in a Patient with Saddle Pulmonary Embolism

Saddle pulmonary embolism (SPE) is an uncommon type of acute pulmonary embolism. It involves the presence of a thrombus where the main pulmonary artery divides into the left and right pulmonary arteries. We present the case of a 53-year-old male who had symptoms of chest pain and dyspnea for a few days prior to visiting the emergency department. Computed tomography pulmonary angiogram (CTPA) revealed SPE, so the patient underwent catheter-directed thrombectomy. A transthoracic echocardiogram completed after the procedure showed a thrombus in the main pulmonary artery and right pulmonary artery. A repeat CTPA demonstrated multiple pulmonary emboli and an embolus in the left pulmonary artery. While in the hospital, he received heparin. On discharge, he was given oral apixaban. Three months later, imaging revealed that the embolism had resolved. This case is unique since a pulmonary embolism was visible on transthoracic echocardiogram, a rare occurrence.