A pulmonary embolism (PE) occurs when a venous thrombotic material Whitener from the lower extremities embolizes to the pulmonary vasculature.Common presenting symptoms include shortness of breath and pleuritic chest pain with vital signs demonstrating hypoxia, tachycardia, and tachypnea.In this paper, we describe a unique presentation of a critically ill patient who developed a saddle SETS pulmonary embolism despite being on prophylactic anticoagulation.