Skip to main content

Saddle embolism is associated with the major adverse events in patients with nonhigh-risk pulmonary embolism


In some patients with acute pulmonary embolism (PE), thrombi may lodge at the levels of bifurcation of the pulmonary trunk and extend into both main pulmonary arteries, forming so-called saddle embolism (SE). The aim of this study was to assess the incidence of SE and whether it is associated with an increased risk of complicated clinical course in patients with nonhigh-risk PE.


Between January 2006 and June 2010, 297 consecutive patients with nonhigh-risk PE that was confirmed with contrast-enhanced spiral computed tomography (CT) in the emergency department were studied. One experienced radiologist evaluated the presence of SE. The clinical information, echocardiographic and CT parameters were reviewed. Patients were divided into SE and non-SE. Multivariate logistic regression was applied to determine factors associated with occurrence of major adverse events (MAE).


Twenty-seven out of 297 patients (9.1%) were found to have a SE. Overall mortality at 1 month was 12.5% with no difference between the groups (11.9% vs. 18.5%, P = 0.32), although SE patients were more likely to receive thrombolytic therapy (8.1% vs. 29.6%, P < 0.01). SE patients had s significantly higher rate of MAE (59.3% vs. 25.6%, P < 0.01). Presence of SE and the ratio of right ventricular to left ventricular diameter were associated with an odds ratio of MAE within 1 month of 2.48 (95% CI: 1.10 to 6.04, P = 0.03) and 3.34 (95% CI: 1.46 to 7.46, P < 0.01).


SE by CT angiography was associated with PE-related shock, intubation, mortality, thrombolysis, and thrombectomy within 1 month in patients with nonhigh-risk PE and may be a useful method for simple risk stratification.

Author information



Corresponding author

Correspondence to H Kim.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Kim, H., Kim, W. Saddle embolism is associated with the major adverse events in patients with nonhigh-risk pulmonary embolism. Crit Care 16, P419 (2012).

Download citation

  • Published:

  • DOI:


  • Compute Tomography
  • Emergency Department
  • Pulmonary Artery
  • Pulmonary Embolism
  • Clinical Information