Pseudo-hemoptysis in postoperative patients as an emergency medical service diagnostic pitfall when evaluating for pulmonary embolism: a case report

This case report describes a postoperative patient whose apparent hemoptysis created a diagnostic challenge.The risk of postoperative venous thromboembolism increases approximately 20-to 40-fold after major surgery.This increased risk is attributed to postoperative immobility, surgery-induced hypercoagulability, and endothelial injury.Hemoptysis is defined as the expectoration of blood or blood-tinged sputum originating from the lungs or tracheobronchial tree.In practice, however, distinguishing true hemoptysis from bleeding that originates in the upper airway or nasopharynx can be difficult.In postoperative patients, hemoptysis is classically associated with pulmonary embolism (PE), although hemoptysis has been reported in only 10%-20% of patients with confirmed PE.Emergency medical services and emergency department clinicians frequently encounter diagnostic uncertainty in this setting, and PE remains commonly missed or misdiagnosed.Approximately 27.5% of patients with PE are initially misdiagnosed in emergency department settings, and recent national data suggest that at least 400 excess deaths from PE occurred in England between April 2021 and March 2022 because of missed diagnoses.