Abdominal pain as pulmonary embolism presentation, usefulness of bedside ultrasound

a report of two cases

Abstract

It is well known that a number of patients affected by hemodynamic stable pulmonary embolism are admitted to the emergency department presenting chest pain without further symptoms of pulmonary embolism, such as dyspnea, cough, hemoptysis, syncope, and tachycardia, but in a few cases, the presenting symptoms are even more unusual. The gold standard for pulmonary embolism diagnosis is computed tomography pulmonary angiogram resulting in significant exposure to ionizing radiation and contrast, but recently bedside ultrasound has shown to be useful in diagnosing pulmonary embolism in the emergency department. We describe two cases of pulmonary embolism in young men evaluated in the emergency department for acute pain of the upper abdomen, preliminarily diagnosed as abdominal colic, in which bedside ultrasound ruled out abdominal diseases and showed basal pulmonary abnormalities consistent with infarction, suggesting the need of diagnostic completion with computed tomography pulmonary angiogram. Bedside ultrasound was useful as complementary imaging test in diagnosing pulmonary embolism in young patients admitted for abdominal pain of unknown origin.