A Case of Large Bilateral Pulmonary Embolism Presenting Only With Dyspnea in a Primary Care Clinic

Pulmonary embolism (PE) is a potentially fatal condition with a wide spectrum of clinical presentations. While dyspnea is the most common presenting symptom, the absence of classic features such as chest pain, hypoxia, or syncope may significantly reduce clinical suspicion, particularly in outpatient settings. We report a case of a 77-year-old female who presented to a family medicine clinic with isolated shortness of breath and minimal objective abnormalities, yet was subsequently found to have extensive bilateral central pulmonary emboli with evidence of right ventricular strain. This case highlights the diagnostic challenge of PE presenting with isolated dyspnea and minimal associated symptoms, particularly in a patient with asthma, where a pre-existing pulmonary diagnosis may contribute to anchoring bias and delay consideration of an alternative etiology.