An 81-year-old man presented with a drop attack, atypical chest pain and sudden onset dyspnoea. After initial physical examination, a transthoracic echocardiography (TTE) examination was performed. In addition to classical echocardiographic findings of pulmonary embolism, there was saddle thrombus at the pulmonary artery (PA) bifurcation (Fig. 1) on TTE. A multidetector computed tomography (MDCT) examination confirmed the findings of TTE (Fig. 2). Enoxoparin and also warfarin therapy was initiated, and then enoxoparin was discontinued when the international normalised ratio was at a therapeutic level. The use of thrombolytic agents in case of haemodynamic instability was planned. Thrombolytic agents were not needed and the clinical course was uneventful. Direct visualisation of thrombus at the PA is very rare by TTE. This case highlights an unusual TTE finding of a patient with pulmonary embolism.
Fig. 1.
Parasternal short axis echocardiographic view: MPA = Main Pulmonary Artery; AO = Aorta; Arrow indicates saddle pulmonary embolus at the pulmonary artery bifurcation
Fig. 2.
The image of MDCT showing saddle thrombus protruding into left and right pulmonary artery