title: A patient with a large pulmonary saddle embolus eluding both clinical gestalt and validated decision rules.
abstract: We report a patient with chest pain who was classified as having low risk for pulmonary embolism with clinical gestalt and accepted clinical decision rules. An inadvertently ordered D-dimer and abnormal result, however, led to the identification of a large saddle embolus. This case illustrates the fallibility of even well-validated decision aids and that an embolism missed by these tools is not necessarily low risk or indicative of a low clot burden.
authors.affiliation: Thomas Jefferson University Hospital, Department of Emergency Medicine, Philadelphia, PA, USA. ahennessey@gmail.com
authors.forename: Adam
authors.initials: A
authors.lastname: Hennessey
authors.forename: Devy A
authors.initials: DA
authors.lastname: Setyono
authors.forename: Wayne Bond
authors.initials: WB
authors.lastname: Lau
authors.forename: Jason Matthew
authors.initials: JM
authors.lastname: Fields
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005863:Gestalt Theory; D006801:Humans; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D