title: Decreasing D-dimer after recent negative computed tomographic pulmonary angiogram does not rule out pulmonary embolism.
abstract: An algorithmic approach to testing utilizing risk stratification and quantitative D-dimer has been considered an acceptable approach to ruling out pulmonary embolism (PE). When D-dimer is elevated, further testing for PE is indicated. However, no evidence exists to guide practitioners when patients return after a recent negative workup for PE who previously had an elevated D-dimer. This case describes a patient who initially had an elevated D-dimer with negative workup for PE who, on repeat visit, had a decreasing D-dimer but was diagnosed with a PE. When evaluating patients after a negative workup for PE after an elevated D-dimer, a decrease in D-dimer cannot be used to rule out PE.
authors: Eastern Virginia Medical School, Sentara Norfolk General Hospital, Department of Emergency Medicine, Norfolk, VA 23507, USA. brucelo1@yahoo.com
authors: Bruce M
authors: BM
authors: Lo
mesh_terms: D000465:Algorithms; D004636:Emergency Service, Hospital; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D