Acute Saddle Embolus With Thrombus in Transit: A Case Report and Review of the Literature

Figures

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  Figure 1. EKG: junctional tachyarrhythmia, left posterior fascicular block, heart rate of 124 beats/minute, and corrected QT of 612 ms.

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  Figure 2. Computed tomography angiography pulmonary embolus series showing saddle embolus. A: Blue arrows showing thrombus occluding the left pulmonary artery. B: Blue arrow showing thrombus occluding the right pulmonary artery.

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  Figure 3. Modified Simpson method. A: Apical two-chamber diastole. B: Apical two-chamber systole. C: Apical four-chamber diastole. D: Apical four-chamber systole. A2C = apical two chamber; A2Cd = apical two chamber diastole; A2Cs = apical two chamber systole; A4Cd = apical four chamber diastole; A4Cs = apical four chamber systole; LV = left ventricular; BP = biplane; EDV = end diastolic volume; EF = ejection fraction; ESV = end systolic volume.

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  Figure 4. Modified Simpson method. A: Apical two-chamber diastole. B: Apical two-chamber systole. C: Apical four-chamber diastole. D: Apical four-chamber systole. A2C = apical two chamber; A2Cd = apical two chamber diastole; A2Cs = apical two chamber systole; A4Cd = apical four chamber diastole; A4Cs = apical four chamber systole; LV = left ventricular; BP = biplane; EDV = end diastolic volume; EF = ejection fraction; ESV = end systolic volume.

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  Figure 5. The pathophysiology of acute pulmonary embolism causing left ventricular systolic dysfunction. PE = pulmonary embolism; PVR = pulmonary vascular resistance; RV = right ventricle; LV = left ventricle.

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  Figure 6. A: The right atrium is mildly dilated with large possibly multilobed elongated mobile mass, originating in the posterior atrium (exact attachment not clear). B: Presumable thrombus prolapsing across the tricuspid valve, cannot exclude another mass lesion.