Pulmonary Embolism Presenting with Abdominal Symptoms

Clinical Presentation

The European Society of Cardiology recommends that abdominal pain is not typically considered a presenting symptom of pulmonary embolism, which primarily includes dyspnea, chest pain, syncope, and hemoptysis 1
Abdominal pain is explicitly described as an "uncommon" and "atypical" presenting symptom in the published literature, with the typical PE presentation focusing on cardiopulmonary symptoms 1, 2

The European Respiratory Society suggests maintaining high clinical suspicion even with atypical presentations, particularly in patients with VTE risk factors, and applying Wells or revised Geneva score regardless of presenting symptom 1
Up to 40% of PE patients have normal oxygen saturation, and therefore, normal oxygen saturation should not be used to exclude PE 1, 3
Proceed with D-dimer or CTPA based on clinical probability scoring, as recommended by the European Respiratory Society 1, 3