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Case Report Volume 13 Issue 1
Conundrum of catch, colic, cavity and clot: puzzled path of pulmonary thromboembolism
Sushil Upadhyay
Received: December 08, 2025 | Published: February 10, 2026
Citation: Upadhyay S. Conundrum of catch, colic, cavity and clot: puzzled path of pulmonary thromboembolism. J Lung Pulm Respir Res. 2026;13(1):4-5. DOI: 10.15406/jlprr.2026.13.00336
Abstract
Background: Pulmonary thromboembolism (PTE) has varied and nonspecific clinical presentations, often leading to diagnostic delays. 1,2 It may mimic pneumonia, myocardial ischemia, or even abdominal pathologies such as renal colic. High clinical suspicion and appropriate imaging are crucial for early diagnosis and management.3 Case presentation: We report the case of a 40-year-old male presenting with acute left-sided chest pain initially suspected to be muscle sprain and then renal colic after a noncontributory chest skiagram. Computed tomography of the kidneys, ureters, and bladder (CT KUB) revealed small bilateral renal calculi, which did not explain his symptoms. High-resolution CT thorax suggested basal consolidation, leading to antibiotic therapy; however, chest pain and hemoptysis persisted. Bronchoscopy demonstrated blood-stained secretions, but cultures and GeneXpert were negative. Despite an initial normal D-dimer, computed tomography pulmonary angiography (CTPA) confirmed thrombi in bilateral lower lobe pulmonary arteries with pleural-based consolidation and cavitation. 3,4 Repeat D-dimer was elevated.5 Venous Doppler was negative for DVT. The patient improved with anticoagulation (LMWH followed by Apixaban).4 Conclusion: This case highlights the diagnostic challenges of PTE presenting with misleading features. A high index of suspicion, even in the presence of atypical presentations and initially normal D-dimer, is essential for timely diagnosis. 5 CTPA remains the gold standard,3 and prompt anticoagulation can lead to excellent outcomes.4
Keywords: pulmonary thromboembolism, chest pain, hemoptysis, diagnostic dilemma, CTPA
©2026 Upadhyay. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.