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

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.