Pulmonary embolism presenting as flank pain: a case series

Michael Amesquita, Michael N Cocchi, Michael W Donnino
Journal of Emergency Medicine 2012, 42 (5): e97-100

BACKGROUND: Pulmonary embolism (PE) is a potentially fatal disease that can be effectively treated once diagnosed. Due to insidious and often cryptogenic presentations, the diagnosis of this disease can easily elude clinicians. Over the last several years the use of computed tomography (CT) scanning has improved the clinician's ability to diagnose PE. In addition, the widespread use of CT to investigate other complaints such as flank and abdominal pain could theoretically result in radiographic findings not previously identified that could point to the diagnosis of PE. The current case series reveals the unexpected and initially unrecognized CT finding of a pulmonary infarct in two patients presenting with flank pain; a third patient presented with flank pain and was also found to have a PE.

OBJECTIVE: We describe three cases of patients who presented to the Emergency Department with flank pain who were diagnosed with pulmonary embolism.

CASE REPORTS: The cases reported here discuss patients who presented with flank pain and were ultimately diagnosed with PE. In the first two cases, the patients had incidental findings of pulmonary infiltrates on abdominal CT scans, which prompted further diagnostic investigation. In the third case, the patient had risk factors for PE and presented with flank pain and the diagnosis was quickly made by CT imaging.

CONCLUSION: Physicians should consider pulmonary embolism in the differential diagnosis of patients with isolated flank pain. Additionally, unexpected pulmonary findings on abdominal CT scans may help suggest the diagnosis of PE in the appropriate clinical setting.

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