The Virtual Hospital: ElectricPE: The Diagnosis of Pulmonary Embolism: Abdominal and Back Pain

ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 10

Abdominal and Back Pain

Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed

This case is a 75 year old woman who developed right subcostal pain 3 months prior to admission. She was treated with antacids intermittently and spent a large percentage of time at home either in a chair or at bedrest. She developed right sided back pain one week before admission. She described the pain as a Òdull acheÓ. At the time of admission she had lost 3 kilograms and was found to have an epigastric mass on physical exam.

She was taken to surgery the day after admission and was found to have a perforated duodenal ulcer, which was repaired.

The chest radiograph obtained on admission showed a right upper lobe mass. The diagnosis at that time was either primary lung carcinoma or metastasis. Further work-up was postponed until the patient had recovered from the exploratory laparotomy.

Chest CT slice taken through the right upper lobe demonstrated a pleural based density that suggested the presence of a lung infarct. Mediastinal images through the same CT demonstrated multiple large clots within the pulmonary arteries on both sides.

Case Assessment
This is a 75 year old female with subacute onset of subcostal pain, weight loss and back pain.

Her abdominal pain was related to a perforated duodenal ulcer while her back pain was caused by the area of pulmonary infarction in the right upper lobe.

1. The chest film is usually abnormal in the presence of pulmonary embolus. However, the findings are often non-specific. (REFERENCE) The finding of infarction on Chest CT can help direct the diagnostic work up.

2. The signs and symptoms of pulmonary embolus are often non-specific. (REFERENCE)

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