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.
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).
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.
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.
Saddle pulmonary embolism is not associated with increase mortality based on shock, hypoxemia, or echcardiographic abnormalities.
Linda Lam, None.