The Second Hit: Delayed Pulmonary Embolism After Minor Trauma and Initially Negative Imaging.

Pulmonary embolism (PE) is a potentially fatal condition, typically associated with known risk factors such as immobility or thrombophilia. This case describes a 55-year-old woman with cardiomegaly who developed PE one week after sustaining minor chest trauma, despite an initially normal D-dimer and CT scan. She later re-presented with worsening respiratory symptoms, and a CT pulmonary angiogram confirmed PE. She was successfully treated with anticoagulation. This case highlights the need for ongoing clinical vigilance for PE, even in low-risk patients with initially unremarkable findings, particularly when symptoms evolve. It demonstrates that even minor chest trauma can precipitate a thromboembolic event and emphasizes that a normal initial assessment should not exclude the possibility of PE if clinical status deteriorates. Furthermore, it underlines the importance of timely reassessment with repeat imaging in the presence of evolving symptoms and highlights that early recognition and prompt initiation of anticoagulation are essential for improving patient outcomes.