Saddle pulmonary embolism (PE) is defined as the presence of a visible thromboembolus that straddles the bifurcation of the main pulmonary artery. It occurs in about 2-5% of all PE cases . Visualization of saddle PE on a Computed Tomography (CT) scan causes alarm among physicians due to the possibility of a large clot burden and impending hemodynamic collapse. However, recent studies have challenged this reflexive assumption, along with the assumption that clot burden predicts outcomes .
Not that saddle PE isn't serious, but all too often the appearance of a “saddle” trumps further thinking about parameters that mean more such as the shock index, biomarkers and echocardiographic assessment of RV function.