Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series

Abstract

Saddle pulmonary embolism (SPE) is a rare type of pulmonary embolism that can lead to hemodynamic compromise causing sudden deaths. Due to a dearth of large prospective studies in this area, little is known regarding the epidemiology, and prognosis and factors affecting the latter for COVID-19-associated SPE. We aimed to describe COVID-19-associated SPE and quantify and compare mortality and factors affecting mortality among the cases. We included a total of 25 publications with a total of 35 cases. The average age was 45 ± 16.3 years with 11 females and 24 males. Dyspnoea (82.5%), orthopnoea (43.5%), and cough (43.5%) were the most common symptoms, and obstructive shock was present in five (21.7%) patients. The average reported oxygen (O2) saturation was 85.8% ± 11.9 mm Hg. Hypertension (26.1%), diabetes (21.7%), and deep vein thrombosis (21.7%) were the most commonly reported comorbidities. Right heart strain was recognized in seven (30%) patients on electroencephalogram (S1QIIITIII) and 12 (52.2%) patients on echocardiogram. Anticoagulation, thrombolysis, and percutaneous intervention were tried in 21 (91.3%), 13 (56.5%), and 6 (26.1%) cases, respectively. Despite the aggressive management, 2 of 25 (8.7%) patients died in our smaller case report cohort. We conclude that despite aggressive management modalities, the mortality of SPE remains high in COVID-19.

Case report of septic pulmonary embolism caused by Staphylococcus aureus combined with multidrug-resistant pulmonary tuberculosis and bronchial tuberculosis

“…SPE is a rare type of pulmonary embolism [7] involving obstruction of the pulmonary artery by a clot containing pathogens, thereby leading to pulmonary arteriole embolism (or pulmonary lobule infarction), septicemia, and focal pulmonary abscess. The pathophysiological basis of SPE involves multiple processes, including infection, thrombosis, embolic events, inflammatory reactions, and tissue damage.…”