Pulmonary embolism: An abdominal pain masquerader

Abdominal pain is an uncommon presenting symptom for pulmonary embolism (PE). A delay in the diagnosis when a patient presents with atypical symptoms can postpone proper treatment and can be catastrophic. We report the case of a 48-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain. Abnormal findings on biliary ultrasound and chest radiograph could have resulted in misdiagnosis. Instead, the physician maintained a high index of suspicion, and further diagnostic testing revealed a large central PE in the right main pulmonary artery. The present article discusses the dangers of using a pattern recognition approach to medical decision making in patients with abdominal pain. Included are the various pathophysiologic mechanisms that may contribute to the development of abdominal pain in patients with PE. Additionally, we review the role of chest radiography in the setting of PE and present the findings that ultimately lead to the diagnosis.