Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. W e present the fi rst known reported case of pulmonary embolism following a celiac plexus block and neurolysis procedure in the outpatient pain clinic setting. CASE PRESENTATIONA 23-year-old woman received a celiac plexus block with lidocaine and bupivacaine, followed by an ablation with 98% dehydrated alcohol diluted with Omnipaque 180 at the L1 level for pain related to chronic pancreatitis. Th e procedure was performed at an off -site pain management clinic. Within 20 minutes of beginning the procedure, the patient experienced a rapid onset of persistent, severe (10/10) right lateral chest pain with radiation to the center of her chest and below her right breast to the epigastric region, accompanied by dyspnea, palpitations, nausea, and vomiting.She arrived at our emergency department (ED) within 30 minutes of symptom onset. Similar pain had not occurred in the past. Apart from her chronic abdominal pain, she denied any fever, chills, wheezing, hemoptysis, extremity swelling or pain, traumatic injury, diarrhea, constipation, or diaphoresis. Th e patient had driven 4 to 5 hours to the off -site pain clinic on the day of presentation. Although she had no recent surgeries, she indicated she had multiple hospitalizations, often for days to weeks at a time, for treatment of chronic pancreatitis. Medications included hydrocodone-acetaminophen (5/325 mg) and etonogestrel, which was implanted 3 weeks before the day of admission. She denied any tobacco, alcohol, or drug use. No family members had venous thrombosis, blood clotting disorders, or vasculitis conditions. Upon arrival at the ED, her blood pressure was 130/100 mm Hg; heart rate, 116 beats/minute; respirations, 18 breaths/minute; pulse oximetry, 98%; and temperature 99.7°F (37.6°C). She was mildly distressed, alert, oriented (×3), and cooperative. Physical exam disclosed only splinting with chest wall breathing movement. An abdominal exam revealed only mild, chronic, epigastric tenderness to palpation. Upper and lower extremities appeared normal with good pulses. Th e neurologic exam was normal. A 12-lead electrocardiogram in the ED demonstrated sinus tachycardia at a rate of 104 beats/minute, a S1QT3 pattern, and additional inverted T waves in V2 to V5 with normal ST segments and normal axis. A chest radiograph showed...