NEGATIVE D-DIMER PULMONARY THROMBOEMBOLISM - A CASE REPORT
Keywords:
sudden onset of breathing difficulty, DVT, PE, D-dimer, CT PA angiogram, Thrombolysis
Abstract
A 42 years old male diagnosed case of right lower limb DVT presented to the emergency department with the h/o sudden onset of breathing difficulty for 4hrs. He was hemodynamically stable. Wells score for DVT was 4 (high risk) &for PE was 9 (high risk). ECG showed T3 & decreased R wave progression in V3-V6. CXR showed straightening of Left heart border. 2D ECHO showed RA, RV dilated, with PASP 50 mm Hg. D-DIMER NEGATIVE. CT PA angiogram showed thrombus in Right& peri- segmental bronchus on Left. The patient was thrombolyzed with Tenecteplase. The patient was hemodynamically stable before & after thrombolysis. As per the PESI (Pulmonary Embolism Severity Index), the patient comes under class 1 with a very low 30-day mortality risk (1-6%).
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References
1. Tintinalli’s emergency medicine; 7th edition; page 430
2. Rosen’s emergency medicine; 7th edition; page1341
3. Bates SM, Ginsberg JS: Treatment of deep-vein thrombosis. N Engl J Med 351: 268, 2004.
4. Mitchell AM, Jones AE, Tumlin JA, Kline JA: incidence of contrast-induced nephropathy after CECT in the outpatient setting. Clin J Am Soc Nephrol 5: 4, 2010
5. Brown MD, Lau j, Nelson RD, Kline JA: Turbidimetric D dimer testing in the diagnosis of pulmonary embolism: a metaanalysis. Clinchem 49: 1846, 2003.
6. Wells PS, Anderson DR, Bormanis J, et al: Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 350: 1796, 1997.
7. Wells PS, Anderson DR, Rodger M, et al: Derivation of a simple clinical model to categorize patients’ probability of pulmonary embolism: increasing the model utility with the Simpli RED D-dimer. Thromb Haemost 83: 418, 2000.
8. Stein PD, Hull RD, Patel KC, et al: D dimer for the exclusion of acute thrombosis and pulmonary embolism: a systemic review. Ann Intern Med 140: 589, 2004.
2. Rosen’s emergency medicine; 7th edition; page1341
3. Bates SM, Ginsberg JS: Treatment of deep-vein thrombosis. N Engl J Med 351: 268, 2004.
4. Mitchell AM, Jones AE, Tumlin JA, Kline JA: incidence of contrast-induced nephropathy after CECT in the outpatient setting. Clin J Am Soc Nephrol 5: 4, 2010
5. Brown MD, Lau j, Nelson RD, Kline JA: Turbidimetric D dimer testing in the diagnosis of pulmonary embolism: a metaanalysis. Clinchem 49: 1846, 2003.
6. Wells PS, Anderson DR, Bormanis J, et al: Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 350: 1796, 1997.
7. Wells PS, Anderson DR, Rodger M, et al: Derivation of a simple clinical model to categorize patients’ probability of pulmonary embolism: increasing the model utility with the Simpli RED D-dimer. Thromb Haemost 83: 418, 2000.
8. Stein PD, Hull RD, Patel KC, et al: D dimer for the exclusion of acute thrombosis and pulmonary embolism: a systemic review. Ann Intern Med 140: 589, 2004.
How to Cite
1.
K. TK, P. MS, Mohammed S. NEGATIVE D-DIMER PULMONARY THROMBOEMBOLISM - A CASE REPORT. Med. res. chronicles [Internet]. 2015Jan.26 [cited 2024Nov.22];2(1):51-5. Available from: https://medrech.com/index.php/medrech/article/view/49
Section
Case Report
