atypical presentation of massive pulmonary embolism, a case report

the lack of pathognomonic signs and symptoms makes the diagnosis of pulmonary embolism (pe) difficult. here, we report a case of a 42-year-old man presented to the emergency department with worsening epigastric pain, hypotension, frank bradycardia, and final diagnosis of pe. although previous studies have indicated that abdominal pain was observed in 6.7% of patients with pe, the exact reason for abdominal pain in pe still remains unknown. tension on the sensory nerve endings, hepatic congestion, and distention of gilson’s capsule are some of the possible mechanisms of abdominal pain in pe. we conclude that emergency physicians should pay more attention to pe, which is an important differential diagnosis of shock state. in this context, rapid ultrasound in shock (rush) should be considered as a vital sign that needs to be evaluated when recording the history of patients presented to the emergency department with signs and symptoms of shock.