Abdominale pijn als atypische presentatie van een longembool

Abstract

Abdominal pain as an atypical presentation of a pulmonary embolism The diagnosis of a pulmonary embolism is frequently missed due to its varying and often subtle presentation. Abdominal complaints can be its only symptom, as was the case with a 55-year-old man. He presented to the emergency department with severe right-sided flank pain. He had no thoracic pain or respiratory complaints. Initially, a bile duct pathology or urolithiasis was considered. Technical studies could, however, not confirm these diagnoses. Based on blood results and imaging studies, the working diagnosis of pneumonia was made, for which antibiotic therapy was started. Because of persistent and unbearable pain complaints, further research was done, showing a saddle pulmonary embolism. Thrombolysis was initiated, after which the patient was admitted to the intensive care unit. The man recovered well and a pulmonary function test 2 months after his hospital discharge showed that everything was normal. Despite multiple case reports in which abdominal pain was the only symptom of a pulmonary embolism, most textbooks do not mention abdominal complaints as a symptom of this condition. The authors of this article therefore argue to always keep in mind the diagnosis of a pulmonary embolism. Especially in case of unexplained abdominal complaints, this diagnosis should always be considered.