PULMONARYEMBOLISMREVEALED BY ABDOMINAL PAIN: A CASE REPORT

Abstract

Introduction:Pulmonaryembolism (PE), one of the leading causes of morbidity in the world, isassociatedwithsignificantmortality, The diversity and lowspecificity of clinical manifestations of PE often lead to misdiagnosis . Correct earlydiagnosis and prompt treatment are therefore key factors in reducing the mortality rate of PE.We report the case of a 58-year-old man treated in the out-patientdepartment of the Mohammed VI ArraziUniversity Hospital in Marrakech (Morocco) for pulmonaryembolism as the reason for revelation of abdominal pain Observation:A 58-year-old man with a history of hypertension, a twelve pack/year smokerwhopresentedwith abdominal pain in the right hypochondrium of suddenonset for twodays, radiating to the right flank, and evolvingperiodically, aggravated by inspiration and feeding. On abdominal ultrasound no gallstones, no distension of the gallbladder and a negativeMurphyssign. Abdominal CT scan showed a small right pleural effusion withatelectasis at the right base on slices through the chest, with no evidence of acute intra-abdominal process.Thoracicangioscanrevealed acute pulmonaryembolism in the segmental branch of the right lower lobe extendingdistallyinto the subsegmental branches the infiltrate in the base of the right lung base mostlikelyrepresents an infarctedlung. It wasdecided to performthrombolysisduringresuscitation, sohewasthrombolyzedwithtwo doses of retaplasehalf an hourapartwithtolerance of the treatmentwithoutsigns of bleeding. Shortlyafterthrombolysiswithretaplase, hiscyanosis and PJV improveddramatically . Discussion:Abdominal presentation of PE isdescribedwith high frequencyit, can manifest as an acute abdominal picturewith right upper abdominal pain with or withoutdefensiveness. The abdominal pain isthought to resultfrom irritation of the pleura on contact with the diaphragm or fromliver congestion secondary to IVD. Conclusion:PE can take on the appearance of variousotherentities and physiciansshouldbeaware of the differentsigns, abdominal pain shouldalert the clinician to the possibility of an extra-abdominal aetiology, including PE, especially in the presence of dyspnoea or polypnoeaincludingsymptoms and radiographicfindingsthatmay lead to this life-savingdiagnosis.