Open Access, Volume 2 Acute thrombectomy for saddle pulmonary embolus: Case presentaton and review of management Case Report www.jcimcr.org Journal of Clinical Images and Medical Case Reports Received: Feb 11, 2021 Accepted: Mar 09, 2021 Published: Mar 11, 2021 Archived: www.jcimcr.org Copyright: © Shukla R (2021). *Corresponding Author: Rajeev Shukla Department of Cardiothoracic Surgery, Monash Medi- cal Centre, Clayton, VIC Australia. Email: drshuklara@gmail.com Abstract Pulmonary embolism is the third leading cause of cardiovascular death afer myocardial infarcton and stroke [1,2,4,5]. Antcoagulaton is the primary choice of treatment for the majority of patents presentng with acute pulmonary embolism [2,4]. However, a greater risk of mor- tality in patents with right ventricular (RV) dysfuncton may open the door to more aggressive treatment modalites [2]. We present the case of a patent who was diagnosed with a post-operatve saddle pulmonary embolus that failed inital treatment with antcoagulaton and required emergency thrombectomy to prevent mortality. A brief overview of treat- ment optons is highlighted. Keywords: Pulmonary embolism management, Pulmonary embolism guidelines, Saddle pulmonary embolism, Catheter based interventon. Rajeev Shukla 1,2 *; Adrian Pakavakis 4 ; Prasanth Sadasivan Nair 1 ; Anna Shukla 3 ; Julian A Smith 1 ; Prashant Joshi 1 1 Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, VIC Australia. 2 Department of Surgery, University of Melbourne, Melbourne, VIC Australia. 3 School of Health Sciences, University of Melbourne, Melbourne, VIC Australia. 4 Department of Intensive Care Medicine, Monash Medical Centre, Clayton, VIC Australia. ISSN 2766-7820 Introducton Pulmonary embolism (PE) has a variable presentaton ranging from incidental discovery in asymptomatc patents to severe hae- modynamically instability, which therefore makes the diagnosis clinically challenging [1,2,3]. Mortality rates three months afer PE are linked to the size of the embolus and the degree of RV strain and have been reported as high as 17% [3]. The mortality rates of patents presentng in cardiogenic shock can be as high as 30% [6]. PE is a preventable disease; with early recogniton and the inita- ton of appropriate treatment, mortality can be prevented and as- sociated morbidity signifcantly improved. Treatment modalites are initated with the aid of risk stratfcaton and deviaton from this can result in potentally dire consequences. Case presentaton A 46-year-old man was admited for management of an acute exacerbaton of Crohn’s disease. His medical history included deep vein thrombosis six weeks earlier with obstructve thrombus in one of the commitant peroneal veins in the midcalf extending to 10 cm but with no extension above the knee. During the hos- pital admission the patent required a semi-electve laparoscopic total colectomy. Afer an inital uncomplicated recovery, the pa- tent developed sudden onset hypoxia (SaO 2 70% RA), sinus tachy- cardia (HR 135) and hypotension (BP 90/70 mmHg) on the sec- ond post-operatve day. The patent required low dose inotropic support with noradrenaline to maintain haemodynamic stability. Electrocardiography demonstrated sinus tachycardia with S1Q3T3 features. A transthoracic echocardiogram (TTE) demonstrated a