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Case Reports
. 2024 Nov 27;16(11):e74623.
doi: 10.7759/cureus.74623. eCollection 2024 Nov.

Pulmonary Embolism Masquerading as Acute Abdominal Pain: A Rare and Challenging Diagnosis

Fatema Jamsheer  1 , Njood Alsudairy  2
Affiliations
Case Reports

Pulmonary Embolism Masquerading as Acute Abdominal Pain: A Rare and Challenging Diagnosis

Fatema Jamsheer et al. Cureus. .

Abstract

Pulmonary embolism (PE) is a potentially fatal condition with variable clinical presentations, ranging from classic respiratory symptoms to rare atypical manifestations. This report describes a 47-year-old woman who presented with acute, severe right upper quadrant abdominal pain, nausea, and vomiting without respiratory complaints. Initial investigations, including abdominal ultrasound and contrast-enhanced CT of the abdomen, revealed no intra-abdominal abnormalities. Elevated D-dimer levels and incidental findings on imaging prompted further evaluation with CT pulmonary angiography, which confirmed bilateral pulmonary emboli. The patient had a history of obesity but no other identifiable thrombotic risk factors. Anticoagulation with low-molecular-weight heparin followed by rivaroxaban led to rapid symptom resolution. Comprehensive thrombophilia screening was negative, and follow-up imaging confirmed the resolution of the emboli. This case highlights the diagnostic challenges posed by PE presenting as isolated abdominal pain, an uncommon but clinically significant phenomenon. A systematic diagnostic approach, including consideration of PE in patients with unexplained abdominal symptoms and elevated D-dimer levels, is critical to avoiding delays in diagnosis and treatment. Early recognition and prompt anticoagulation therapy are essential for preventing potentially fatal outcomes and ensuring optimal patient care.

Keywords: acute abdominal pain; anticoagulation therapy; atypical presentation; case report; ct pulmonary angiography; d-dimer; diagnostic challenge; diaphragmatic irritation; idiopathic thromboembolism; pulmonary embolism.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Salmaniya Medical Complex Ethics Committee issued approval N/A. In compliance with ethical review procedures, Institutional Review Board waivers are granted for case reports, recognizing their inherent nature and the absence of identifiable risks. This allowance facilitates the responsible dissemination of valuable clinical insights without the need for formal approval. Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Axial CT pulmonary angiography image
It demonstrates bilateral filling defects (arrow) consistent with acute pulmonary embolism.
See this image and copyright information in PMC

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