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Abstract: Poster Presentations |

CHARACTERISTICS AND PROGNOSTIC FACTORS OF PULMONARY SADDLE EMBOLUS FREE TO VIEW

Linda M. Lam, DO*; George Matuschak, MD; Stephen Trottier, MD
Author and Funding Information

Saint Louis University, Saint Louis, MO


Chest


Chest. 2005;128(4_MeetingAbstracts):405S. doi:10.1378/chest.128.4_MeetingAbstracts.405S-b
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Abstract

PURPOSE:  Pulmonary saddle embolism is a radiographic description of massive embolization implicitly assumed to confer increased mortality. However, supportive data are scant. This is a review of 19 patients with a pulmonary saddle embolus over a 5 year period at a university medical center, hypothesizing that: 1) such patients exhibit increased mortality; and 2) discrete prognostic factors stratify these and other adverse outcomes.

METHODS:  The medical records of patients between June 1999 and June 2004 were retrieved to identify those with pulmonary saddle embolus on helical CT chest . Data collection included demographic data, APACHE II score, shock defined as requiring vasopressors and/or MAP < 60 mmHg, need for mechanical ventilation, PaO2/FIO2 ratio, presence of deep venous thrombosis, echocardiographic findings, and hospital morbidity and mortality. Data was summarized by median calculation, means ± standard error and evaluated by X2 analysis, and bivariate correlation (SPSS v. 13 .0).

RESULTS:  Saddle embolism was diagnosed in 6 females and 13 males (total n = 19), representing an incidence of 1.2%. Mean age was 58.2 years old +/- SD 16.34 and median Apache II score of 9 (range 4-26). Five patients presented with hemodynamic instability, of which 2 patients demonstrated right ventricular systolic dysfunction. RV dilation found in 7/10 patients. Co-existing deep vein thrombosis found in 10 patients and superficial thrombophebitis in 4 patients. Median Pa02/FIO2 ratio found to be 233 (range 53-395). Four patients (22 %) required mechanical ventilation. No patients received thrombolytics. Seventeen (94 %) patients were anticoagulated with heparin infusion. No significant correlation existed among shock, occurrence or type of echocardiographic abnormalities, and degree of hypoxemia. All patients survived.

CONCLUSION:  Saddle pulmonary embolism is not consistently associated with shock, echocardiographic abnormalities, or hypoxemia in patients surviving the initial embolic event who were treated by standard anticoagulation regimens and/or caval interruption.

CLINICAL IMPLICATIONS:  Saddle pulmonary embolism is not associated with increase mortality based on shock, hypoxemia, or echcardiographic abnormalities.

DISCLOSURE:  Linda Lam, None.

12:30 PM - 2:00 PM


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