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Electrocardiogram on presentation showing sinus tachycardia with a heart rate of 115 beats per minute, T wave inversions in leads III and V3.
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Her electrocardiogram (Fig. 1) on presentation showed sinus tachycardia with a heart rate of 115 beats per minute, T wave inversions in leads III and V3 and chest X-ray showed a widened superior mediastinum (Fig. 2).
Echocardiogram: apical four-chamber view showing dilated right ventricle (RV). RA, right atrium; LA, left atrium; LV, left ventricle.
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It showed moderate to severe RV enlargement, moderately hypokinetic right ventricle, abnormal atrial and ventricular and septal motion and mild pulmonary hypertension (Fig. 3).
CT of the chest showing saddle emboli (white arrows) in main pulmonary artery (MPA), right pulmonary artery (red arrow) and left pulmonary artery (LPA). AA, ascending aorta; SVC, superior vena cava; DA, descending aorta.
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Computed tomography (CT) of the chest with intravenous contrast (Fig. 4) confirmed our diagnosis of acute PE and showed 'saddle embolus' involving the main pulmonary artery extending into both right and left pulmonary arteries and associated secondary and tertiary branches.  
Gross specimen of saddle pulmonary embolus.
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Patient underwent pulmonary embolectomy, and large saddle embolus was removed (Figs 5 and 6).
Histopathology of pulmonary thromboemboli.
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Patient underwent pulmonary embolectomy, and large saddle embolus was removed (Figs 5 and 6).