Low Back Pain Revealing Bilateral ProximalPulmonary Embolism with COVID-19

• Fatma Hbaieb

Background: Pulmonary embolism (PE) is frequently encountered in emergency departments. It is a serious
condition with significant morbidity and mortality. A high prevalence of thromboembolic events has been
reported with COVID-19. The similarity in clinical presentation between the two diseases makes accurate
diagnosis even more difficult. Atypical presentations can lead to delayed diagnosis and treatment, with a fatal
outcome within hours. We report the case of a man who presented to the emergency department with bilateral
low back pain as a presenting sign of bilateral proximal PE due to COVID-19. 
Case Report: A 35-year-old man visited the emergency department for bilateral low back pain with a fever.
His medical history included type 2 diabetes. Vital signs were as follows: blood pressure was 120/80 mmHg,
heart rate was 110 bpm, respiratory rate was 21cpm, desaturation of 80% on room air and temperature was
37.8°C. An unprepared abdominal radiograph revealed significant aerosols. A thoracoabdominal-pelvic CT
scan was performed revealing bilateral proximal pulmonary embolism with a floating thrombus of the main
pulmonary artery associated with signs of severity and extensive COVID-19 pneumonia on the CT scan.
Anticoagulation was initiated and the patient was transferred to the COVID-19 unit. 
Conclusion: The diagnosis of PE should always be considered in the presence of any abdominal or lumbar
pain of undetermined etiology. The presence of atypical pain in a patient with COVID-19 pneumonia could
be a sign of a discrete evolving PE, which should be diagnosed as early as possible to ensure timely and
appropriate management. 

• PDF

Copyright (c) 2024 Tunisian Journal of Emergency Medicine

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

THE tjem allows authors to retain unrestricted copyright and full publishing rights of their articles.

All articles published in this journal are openly accessible and licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This guarantees that anyone is free to:

• Share: Copy and redistribute the material in any medium or format.

• Adapt: Remix, transform, and build upon the material for any purpose, even commercially.

Under the following terms:

• Attribution: Users must give appropriate credit to the original author(s) and the journal, provide a link to the license, and indicate if changes were made.

By submitting a manuscript to tjem, authors grant the journal the right of first publication, while retaining full ownership of their intellectual property.