# Pulmonary Embolism Presenting As Shoulder and Back Pain: A Case Report

## TL;DR

A patient presented with shoulder and back pain instead of typical symptoms of pulmonary embolism, highlighting the need to recognize atypical signs for timely diagnosis.

## Contribution

The case report highlights shoulder and back pain as an atypical presentation of pulmonary embolism.

## Key findings

- The patient presented with left shoulder and left-sided pleuritic back pain as the main symptoms.
- The patient was diagnosed with a left-sided pulmonary embolism after being managed in the emergency department.
- Recognizing rare symptoms can reduce morbidity and mortality from pulmonary embolism.

## Abstract

Pulmonary embolism (PE) is a common but life-threatening condition, and diagnosis can be challenging. Diagnosis is even more difficult in those patients with atypical presentations such as the absence of pleuritic chest pain, dyspnoea, tachycardia, or symptoms of deep vein thrombosis. We have delineated shoulder and back pain as an atypical sign of PE. However, the significant amount of misdiagnosis highlights the importance of other rare symptoms of this potentially fatal disease. Therefore, eliciting these rare presenting symptoms can significantly reduce morbidity and mortality. Here, we report the case of a patient who, 13 days after a laparoscopic Nissen fundoplication, presented to the emergency department (ED) with left shoulder and left-sided pleuritic back pain. She was managed in the resuscitation area in the ED and was subsequently diagnosed with a left-sided PE. Her care was taken over by the medical team, and she continued her recovery in the acute medical unit.