Persistent hiccups as the presenting symptom of a pulmonary embolism

An 81-year-old male with a history of symptomatic bradycardia controlled by a pacemaker presented to our institution with three days of persistent hiccups. He denied any pulmonary symptoms and his initial evaluation showed no evidence of tachypnea, tachycardia, or hypoxia. Pacemaker malfunction or migration of the pacer leads was ruled out as an etiology and no intracranial pathology was present. Admission chest radiograph was normal but a computed tomography of the chest demonstrated a left lower lobe pulmonary embolus. After treatment with anticoagulation was initiated, the hiccups resolved within the next week. This is a unique case presentation of hiccups as the only presenting symptom of an otherwise asymptomatic pulmonary embolism.