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Endgames Spot Diagnosis

Atypical chest pain in an older woman

BMJ 2018; 360 doi: (Published 22 February 2018) Cite this as: BMJ 2018;360:k345
  1. Omed Amin, foundation year two doctor,
  2. David C Howlett, consultant radiologist
  1. Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
  1. Correspondence to O Amin omedamin{at}

A 73 year old woman with no cardiac history presented with a three week history of atypical chest pain. She had no associated signs or symptoms. She was referred for a computed tomography coronary angiogram (fig 1) at the rapid access chest pain clinic, as part of routine investigations for atypical chest pain.

Fig 1

Arterial phase computed tomography coronary angiogram

What is the diagnosis?


The computed tomography coronary angiogram shows extensive bilateral pulmonary emboli (fig 2).

Fig 2

Arterial phase computed tomography coronary angiogram reveals extensive pulmonary emboli within the distal main right …

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