Low Back Pain Revealing Bilateral ProximalPulmonary Embolism with COVID-19

Abstract

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.