A Silent Saddle Embolism: Syncope Without Dyspnea or Chest Pain

Pulmonary embolism (PE) is a potentially fatal diagnosis that may present without classic symptoms. We describe a rare presentation of a submassive saddle PE manifesting solely as syncope, without dyspnea or chest pain. The patient was found to have significant right ventricular dysfunction and myocardial injury with elevated troponin and was ultimately diagnosed with a large saddle PE and successfully treated with catheter-directed thrombectomy and anticoagulation. This case underscores the importance of echocardiographic RV assessment and early imaging in syncope workup to avoid delayed or missed PE diagnoses.