Hiccups as Rare Presentation of Bilateral Pulmonary Embolism: Case Report

Pulmonary embolism is considered a life-threatening condition, with a variable spectrum of clinical presentations. Dyspnea, hemoptysis, and chest pain are the classical symptoms; however, atypical presentations may delay the diagnosis. Persistent hiccups as the sole presentation of pulmonary embolism are rarely reported, posing a diagnostic challenge. Identifying this rare presentation is paramount for early diagnosis and improving patient outcomes.

A 76-year-old Egyptian man was admitted with persistent, daily hiccups lasting ~2 months, refractory to conservative and pharmacologic measures. He denied chest pain, dyspnea, or any respiratory or gastrointestinal symptoms. On admission, physical examination was unremarkable, while laboratory testing revealed an elevated D-dimer level. On hospital day 1, lower limb Doppler ultrasound demonstrated acute deep vein thrombosis in the right lower extremity. Subsequently, CT pulmonary angiography confirmed bilateral pulmonary embolism.

This case highlights persistent hiccups as the sole manifestation of pulmonary embolism. Clinicians should maintain a high index of suspicion for pulmonary embolism in elderly patients presenting with persistent, unexplained hiccups particularly after common causes of hiccups have been excluded. Early diagnosis and timely treatment are crucial to reducing morbidity and improving patient outcomes in such atypical presentations.