Pulmonary embolism with aortic saddle embolism: a rare presentation

Area of Science:

• Cardiology
• Vascular Surgery
• Emergency Medicine

Background:

• Thromboembolic events, including pulmonary embolism (PE) and aortic embolism, pose significant clinical challenges.
• Risk factors such as recent surgery and immobilization increase the likelihood of developing thromboembolic disease.
• Simultaneous PE and aortic saddle embolism is an exceptionally rare presentation.

Observation:

• A patient with a history of tibia fracture surgery and immobilization presented with symptoms suggestive of acute embolism.
• Diagnostic imaging confirmed the presence of bilateral pulmonary artery embolism and an aortic saddle embolus.
• The patient's clinical condition necessitated urgent and aggressive intervention.

Findings:

• Emergency bilateral pulmonary artery catheter-directed thrombolysis was performed to address the PE.
• Following thrombolysis, bilateral transfemoral embolectomy was undertaken to remove the aortic saddle embolus.
• The management strategy balanced the benefits of reperfusion against the risks of bleeding, particularly in the context of recent surgery.

Implications:

• This case highlights the complexities in managing rare, simultaneous embolic events affecting both the pulmonary and systemic arterial circulations.
• Current treatment guidelines for such combined embolic phenomena are not well-established, necessitating individualized treatment approaches.
• Sharing this experience provides valuable insights into the challenges and potential therapeutic options for clinicians facing similar critical scenarios.