Pulmonary thromboembolism presenting with hoarseness of voice

A young man in his late 30s with a history of pulmonary tuberculosis presented with complaints of hoarseness of voice persisting for 6 months. Chest auscultation revealed diminished breath sounds over the right lung field. An initial chest X-ray showed collapse of the right lung with mediastinal shift towards right. Fibreoptic laryngoscopy revealed sluggish movement of the left vocal cord. CT neck showed focal nodular thickening in the left false vocal cord and thrombus in the right main pulmonary artery. The subsequent CT pulmonary angiogram performed revealed right pulmonary thromboembolism and dilated main pulmonary artery which were treated with anticoagulants. There was a partial improvement of symptoms. Pulmonary thromboembolism (PTE) is a life-threatening condition often presenting with dyspnoea, chest pain and haemoptysis. However, atypical presentations can challenge diagnosis and delay treatment initiation. Timely diagnosis and initiation of anticoagulation therapy are crucial to prevent complications and improve outcomes in patients with PTE presenting with unusual manifestations.