A Case of Asymptomatic Bilateral Large Pulmonary Embolism Masquerading as ST Elevation Myocardial Infarction

Waldenström Macroglobulinemia Mimicking A Primary Lung Carcinoma

Abstract

Pulmonary embolism (PE) is a common and life-threatening medical emergency, but it is still often misdiagnosed due to its wide variety of clinical manifestations. We report a case of a 78-year-old man who presented with urinary retention without any classical symptoms, and was found to have bilateral large PE as confirmed by computed tomography pulmonary angiogram. Initial electrocardiogram (ECG) showed ST segment elevation and T-wave inversion in anteroseptal and inferior leads, with reciprocal changes in lateral leads. Clinicians need to be aware that a diagnostic dilemma between PE and acute coronary syndrome is not uncommon, as both conditions can present with “ischemic-looking” ECG and elevated troponin levels. To our knowledge, this is the first case of an atypical, incidental finding of PE in a patient who presented with urinary retention reported in the literature. Careful analysis and interpretation of ECG are necessary to improve patient evaluation and support clinical decision-making in order to provide the best possible care.