Which symptom is least characteristic of a pulmonary embolism?

• A. Sudden dyspnea
• B. Pleuritic chest pain
• C. Slow onset shortness of breath
• D. Hemoptysis

Answer: (C)

Pulmonary embolism tends to present as an abrupt event. A clot suddenly lodges in a pulmonary artery, causing a rapid mismatch of ventilation and perfusion and a quick drop in oxygen levels. Because of that, sudden dyspnea is a hallmark, and pleuritic chest pain often results from irritation of the lung and pleura as the infarct develops. Hemoptysis can occur when part of the lung tissue becomes infarcted, but it’s less common than the sudden breathing difficulty or pleuritic pain. Slow-onset shortness of breath, by contrast, is not typical for PE because the clinical picture is usually sudden rather than gradual. If symptoms evolve slowly, other causes like heart failure, COPD, or deconditioning are more likely.