title: Misinterpreting risk and test results delays diagnosis in a patient with pulmonary embolism.
abstract: We report the case of a middle-aged man where a diagnosis of pulmonary embolism (PE) was delayed due to initial underestimation of risk and over-reliance on D-dimer testing. The patient presented with pleuritic chest pain after a 5 h domestic flight. The treating clinicians presumed that this duration of immobilisation was insufficient to cause a PE, D-dimer was not measured and the patient was discharged home. One week later, the patient re-presented due to persistence of chest pain. On this occasion, D-dimer was measured and it was normal, which was interpreted as excluding a PE. Subsequently, a CT pulmonary angiogram was performed, which demonstrated a subsegmental PE. This case highlights the importance of accurate assessment of PE-risk factors and following clinical guidelines, since a delayed diagnosis of PE is associated with increased mortality.
authors.affiliation: Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
authors.forename: Sam
authors.initials: S
authors.lastname: Babak
authors.affiliation: School of Medicine, Griffith University, Queensland, Australia.
authors.forename: Krishna B
authors.initials: KB
authors.lastname: Sriram
mesh_terms: D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005492:Folic Acid / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014748:Vinca Alkaloids
chemical_list: C556242:EC 0489; D005338:Fibrin Fibrinogen Degradation Products; D014748:Vinca Alkaloids; C036309:fibrin fragment D; D005492:Folic Acid