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We describe a 39-year-old male who presented with acute PE complicated by pulmonary infarction, confirmed by computed tomography pulmonary angiography 2\u2009weeks following laparoscopic appendectomy. His initial symptom was right lower-back pain. This case underscores the diagnostic challenge posed by an atypical presentation of PE, in which isolated back pain was the sole initial manifestation. Furthermore, we delineate the pathophysiologic mechanisms that may account for PE presenting initially as isolated back pain, knowledge that could expedite early recognition and guideline-directed anticoagulation.<\/jats:p>","DOI":"10.1177\/23247096261429177","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T09:53:34Z","timestamp":1772272414000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Embolism Presenting as Backache After Appendectomy: An Atypical Presentation of a Common Diagnosis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7292-1974","authenticated-orcid":false,"given":"Songjun","family":"Shao","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China"},{"name":"Department of Respiratory and Critical Care Medicine, Guizhou Provincial People\u2019s Hospital, Guiyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoju","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengming","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2023.05.003"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2024.03.003"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2642-0241"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30514-1"},{"issue":"4","key":"e_1_3_3_6_2","article-title":"National trends in emergency conditions through the omicron COVID-19 wave in commercial and medicare advantage enrollees","volume":"4","author":"Stevens MA","year":"2023","unstructured":"Stevens MA, Melnick ER, Savitz ST, et al. 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