Postoperative sudden onset of shortness of breath and sharp pleuritic chest pain suggests which condition?

• A. Pneumothorax
• B. Myocardial infarction
• C. Aortic dissection
• D. Pulmonary embolism

Answer: (D)

Presents with sudden shortness of breath and sharp pleuritic chest pain after surgery is most suggestive of a pulmonary embolism. After surgery, immobility and inflammation increase the risk of blood clots forming in the legs and traveling to the lungs. An embolus blocking pulmonary arteries causes a rapid drop in perfusion and a mismatch between air reaching the lungs and blood flow, triggering sudden dyspnea and sharp pleuritic pain that worsens with deep breaths as the pleura irritated by the blocked vessels rubs.

Pneumothorax can also cause acute dyspnea and chest pain, but it more often shows unilateral changes on exam, such as decreased breath sounds and hyperresonance. Myocardial infarction usually presents with pressure-like or squeezing chest pain rather than sharp pleuritic pain. Aortic dissection typically presents with sudden severe tearing pain, sometimes with differences in blood pressure or pulse between limbs. So the described postoperative presentation aligns best with pulmonary embolism.