Saddle pulmonary embolism

saddle pulmonary embolism

Define saddle pulmonary embolism:

Saddle pulmonary embolism is an uncommon type of venous thromboembolism that can lead to sudden hemodynamic collapse and death. In saddle PE, a large clot sits atop or “saddles” the main pulmonary artery where it divides and branches into the left and right lungs. It can cause breathing problems


The main pulmonary artery carries deoxygenated blood from the heart to the lungs where it becomes reoxygenated.  A saddle PE usually begins as a blood clot in the veins of the legs or another part of the body. The entire clot or a part of it can be carried into the lungs. There are several causes and types of blood clots. Some factors that can increase a person’s risk of developing blood clots are below.

Reduced or impaired blood flow:

Reduced or impaired blood flow can cause blood to pool in the vessels, increasing the risk of blood clots. Some factors that can affect blood flow include:

   Wearing cast


    Sitting for more than 4-6 hours at a time, such as in a car or airplane

    Not moving for long periods due to bed rest, trauma, or injury

Increased estrogen:

Increased levels of the hormone estrogen can increase the risk of blood clots. Some factors that may cause a rise in estrogen levels include:

    Pregnancy, which may increase the risk of blood clots by five times

    Contraceptive pills and hormone medications

     Childbirth, especially 6 weeks after delivery

     Hormone replacement therapy

Some of the conditions include:


Congestive heart failure

Deep vein thrombosis (DVT)

High blood pressure

Other conditions that may raise your risk of blood clots include:



High cholesterol

Chronic kidney disease



Signs of PE include:

Chest pain

Excessive sweating


Rapid or irregular heartbeat

Fainting or loss of consciousness

Lightheadedness or dizziness


A person with saddle PE requires immediate medical attention and may require admission to an intensive care unit at the hospital. Some of the treatment options are given below:

Blood thinner (anticoagulant) injection

Removing the clot via a catheter within your blood vessels

Blood thinner oral medications


Medications used to dissolve or break down clots in the body can also lead to PE. This happens when a clot or a piece of one breaks off a wall of the blood vessels and travels to the lungs. Clot-busting drugs are called thrombolytics, they include:

Streptokinase (Streptase)

Anistreplase (eminase)

Other medical treatments and conditions that may cause to form in the body include:

Birth control pills

Blood transfusion



Hormone therapy

Some vitamins, minerals, and supplements

If you get any symptoms or disease tell your doctor. 


You can’t always prevent a saddle PE from happening. It can happen for no exact reason or because of an underlying condition or reason that you can’t prevent. However, you may be able to reduce your risk of a saddle PE by keeping your risk factors for blood clots in check. Here are a few things you can do:

Avoid smoking

Avoid sitting or lying for long periods

Wear compression stocking

Keep your blood sugar balanced 

Keep up exercise daily


SPE is a rare diagnosis but has a range of clinical presentations. Most patients are not hypotensive or hypoxic on presentation, and saddle PE was not suspected initially. When diagnosed, there is a high associated inpatient mortality as we report here in a diverse, unburn minority patient population. Ventilation scans may not be the ideal next step in the evaluation of PE in low and intermediate-pretest probability patients due to their inability to diagnose SPE. Right heart thromboembolism carries significant inpatient mortality and may require more aggressive treatment.


Saddle PE can cause life-threatening complications. The outlook for people with saddle PE is similar to those with other types of PEs. In some cases, the clot may dissolve on its own. A 2014 study found that the mortality rate for saddle PE was 3.62 percent, compared to 3.29 percent for people with other types of PE. however, other health complications were higher in people with saddle PE. These complications include:

Heart failure

Heart attack


Respiratory failure

Need for further thrombolytic treatment

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