The diagnosis of pulmonary embolism despite a negative D-dimer assay: the importance of individualised clinical assessment and other investigations
Year: 2025
Type: article
Study design: Case Report
Abstract: Pulmonary embolism is an important differential diagnosis in the work up of patients presenting with chest pain and respiratory symptoms. Left untreated, it carries a high mortality. Pulmonary embolism presents a diagnostic challenge as the clinical presentation varies widely. Hospitals in the United Kingdom frequently use the validated D-dimer assay as an initial 'rule-out' test for low-risk patients. We present the case of a 69-year-old woman, presenting with chest pain and cough. She was deemed low-risk for pulmonary embolism using validated scoring systems and had a negative D-dimer assay, however clinical suspicion and chest X-ray findings lead to further investigation with computed tomography pulmonary angiography. This revealed a suspected pulmonary infarct, and the diagnosis of pulmonary embolism was made. This report highlights that while the D-dimer assay and Wells score are useful tools in the work-up for pulmonary embolism, they should not replace careful clinical assessment. We also explore X-ray findings pertinent to this case and their association with pulmonary embolism. LEARNING POINTS: The D-dimer assay is a useful test in the work-up for suspected pulmonary embolism when used alongside a validated risk stratification tool, however this should not replace careful clinical judgement.While typically used to rule out alternative pathology, chest radiographs can occasionally show changes related to pulmonary embolism.
DOI: 10.12890/2025_005851
Author: Connor Thompson
Institution: Northumbria Specialist Emergency Care Hospital
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $323
OpenAlex ID: W4415360250