I seem to recall recent discussion about the use of d-dimers in PE, and
would like to share a recent case in which there was a near catastrophe.
A 45 year old man presented to A&E 7days post-herniorrhaphy complaining of
shortness of breath and pleuritic chest pain. Apart from a slight
tachypnoea, physical exam revealed nothing of note, and ECG and CXR were
normal. The A&E SHO referred him to the physicians as a ?PE. They found a
negative D-dimer, and on that basis sent him home with a diagnosis of
"viral pleurisy". You can guess the rest - he came back three days later in
a near-parlous state with an obvious full-blown PE, and on this occasion
D-dimers were positive.
I know the 'evidence' stacks up in favour of D-dimers, and I know that
'anecdotal' evidence just isn't good enough, but believe me, you can't beat
an on-your-doorstep case like this colouring your view of how things should
be done!!
Lawrence Jaffey
Liverpool
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