Pulmonary Tumour Embolism from Gastric Adenocarcinoma Causing Respiratory and Cardiac Failure may not be Identified on Standard Ante-Mortem Imaging.

Pulmonary tumour embolism is severe complication of malignancy, often presenting with progressive dyspnoea and respiratory failure. Due to their non-specific symptoms and absence of clear imaging findings, diagnosis is frequently delayed or made post-mortem. This is a case of previously undiagnosed gastric adenocarcinoma presenting with rapidly worsening respiratory symptoms: hypoxaemia, pulmonary hypertension and heart failure. Standard imagining - computed tomography angiography and echocardiography - provide indirect evidence, definitive diagnosis of pulmonary tumour embolism confirmed post-mortem. This case highlights the diagnostic challenges associated with a pulmonary tumour embolism and underscores the importance of early suspicion of malignancy-related complications in cases of progressive respiratory and cardiac failure without radiographic evidence of pulmonary embolism. LEARNING POINTS: Standard diagnostic imaging lacks specificity and fails to detect pulmonary tumour embolism. Computed tomography angiography and echocardiography provide indirect evidence, but definitive diagnosis often requires histopathological confirmation, frequently post-mortem.