• Ammad Akram, Mehwish Gilani, and Khurshid Muhammad.
• Department of Internal Medicine, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
• J Coll Physicians Surg Pak. 2023 Jan 1; 33 (1): 535553-55.

AbstractPulmonary Embolism (PE) is an elusive entity that has long baffled physicians. At times, it can present as a diagnostic and therapeutic challenge. The aim of this report is to emphasise that high altitude is one of the risk factors for PE. Physicians must keep a high index of suspicion for PE, especially in patients being evacuated from high altitudes with respiratory symptoms. A case of massive PE with right ventricular clots initially suspected to be high altitude-associated pulmonary edema (HAPE) and then novel coronavirus disease 2019 (COVID-19) pneumonia was managed. Computed tomography (CT) pulmonary angiography could not be done initially. The case was managed in intensive care settings. The patient had to be treated with thrombolytic therapy owing to hemodynamic compromise. Significant clinical improvement was noted after thrombolysis. A high index of suspicion is required for the diagnosis and management of PE. If standard imaging techniques cannot be used due to clinical constraints, ancillary techniques must be effectively employed during management. Key Words: Pulmonary embolism, Thrombolysis, High altitude, COVID-19.

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