When a 91-year-old woman presents with shortness of breath and back pain, the initial concern might be pneumonia or a musculoskeletal issue—but what if it’s much more? This case unravels into a multi-system diagnostic challenge involving pulmonary embolism, atrial fibrillation with RVR, and suspicious findings pointing to possible metastatic disease. It’s a deep dive into the complexity of geriatric presentations—and the clinical judgment required when intervention decisions aren’t clear-cut.Key Topics Covered: