Pulmonary thromboembolism masquerading as bronchial asthma in a remote medical setup at extreme high altitude

Pulmonary thromboembolism (PTE) is a life-threatening illness. It is a great masquerader that mimics many respiratory illnesses, warranting a high index of suspicion for diagnosis. It should be suspected when respiratory illnesses do not respond to the expected course of treatment. At this point, additional imaging modalities such as echocardiography and CT scans can assist with the diagnosis; however, these facilities are usually not available in remote medical setups such as mountainous regions in the Himalayas. The definitive diagnosis is delayed until the patient is brought down to a well-equipped hospital at a lower altitude. Making an early provisional diagnosis is hence crucial for timely evacuation and optimal first-line management to circumvent associated morbidity and mortality.We present a case of PTE in a remote medical establishment whose initial evaluation pointed towards an episode of severe asthma. The poor response to standard management prompted us to undertake bedside echocardiography to diagnose features of PTE.