the causes of pulmonary embolism can be venous thromboembolism , and nonthrombotic embolism like septic , fat , air , amniotic fluid and tumour embolism .
tumour embolism to lungs can arise from cancers of breast , stomach , liver , kidney and rarely from choriocarcinoma .
choriocarcinoma is a malignant , trophoblastic cancer , belonging to the malignant end of the spectrum in gestational trophoblastic disease , which can occur following molar pregnancy , ectopic pregnancy , abortion and even normal pregnancy [ 2 , 3 ] .
choriocarcinomas spread via blood and lymphatics with early haematogenous spread to lungs , resulting in pulmonary embolism , pulmonary oedema , pulmonary hypertension or acute respiratory distress syndrome . in a young female presenting with persistent shortness of breath , cough and chest pain ,
the possibility of metastatic pulmonary embolism should be considered as surgery and chemotherapy can cure the choriocarcinoma metastasizing to the lungs .
a 25-year - old lady was admitted in the pulmonology ward with the diagnosis of pneumonia .
the patient had presented with a history of progressive shortness of breath , chest pain and persistent cough with occasional haemoptysis .
she had a history of being treated with antibiotics and anti - tb drugs in outpatient basis .
since her symptoms were persistent and her general condition was deteriorating , she was admitted to the ward . on examination , she had crepitations in bilateral chest and an oxygen saturation of only 80% .
cect chest was done , which revealed pulmonary embolus occluding the main pulmonary artery , and right and left pulmonary arteries ( fig .  1 ) .
serum beta - human chorionic gonadotrophin ( hcg ) level was found to be significantly high .
she was managed further with chemotherapy ( emaco regimen ) with excellent response to the treatment . 

figure  3:histopathological image showing the trophoblastic elements . a ct scan image showing thrombus in the pulmonary artery .
women in the reproductive age group with lung metastasis present with dyspnoea , chest pain , cough and haemoptysis . as the diagnosis can always be misleading and patient might be treated in the line of pneumonia or tuberculosis , it is very essential to have a high index of suspicion .
surgery is indicated in patients with haemodynamic instability and those with massive tumour burden occluding main pulmonary and branch pulmonary arteries .
so , chemotherapy should be initiated as soon as the diagnosis is strongly suspected or confirmed .
pulmonary embolism due to choriocarcinoma should always be suspected in a reproductive age woman presenting with intractable shortness of breath .
 pulmonary embolism carries a significant morbidity and mortality . 
 metastatic choriocarcinoma presenting as pulmonary embolism is a rare event . here , we report a case of a 25-year - lady with a history of worsening shortness of breath for 4 months who was treated as a case of pneumonia and tuberculosis . owing to the worsening condition , 
 she had a contrast enhanced computed tomography ( cect ) chest done and was diagnosed to have pulmonary embolism . 
 she underwent pulmonary embolectomy . 
 the histopathological examination of the embolus revealed it to be metastatic choriocarcinoma . 
 she showed a good response to chemotherapy . 
 metastatic choriocarcinoma should be considered as a differential diagnosis in females presenting with pulmonary embolism . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONFLICT OF INTEREST STATEMENT