Severe Pulmonary Embolism with Negative D-Dimer-Testing

Abstract

A 46 year old female Caucasian was admitted with shortness of breath on exertion, productive cough and hemoptysis few days of duration without any other chronicle diseases. She had recent history of sigmadiverticulitis treated with antibiotic and hysterectomy a year ago because of hypermenorrhoe. Vital signs were stable without any clinical signs of a deep venous thrombosis. The electrocardiogram (ECG) showed sinus rhythm with an incomplete right bundle branch block. Laboratory tests revealed a negative d-dimer (Latex-method). We assessed a contrast enhanced computed tomography scan (CT) of the chest illustrating surprisingly a severe pulmonary embolism in the right lung (main bronchus of the lower lob). Several further examinations ruled out malignant diseases or favorable thrombosis. Treatment of the patient was established using low molecular weight heparin (subcutaneously administered), switched to rivaroxaban at the end of the in-hospital duration. Discharge was carried out after eight days in stable conditions. Anticoagulation was prescribed for three months. D-dimer testing is clinically established to rule out embolism/ thrombosis laboratorial despite of arterial or venous location. This is a unique case, where the laboratorial testing failed to detect a severe pulmonary embolism while the sensitivity for the d-dimer testing tends in general high. Clinically, the imaging approach (computed tomography scan of the chest) reflects “the gold standard” for pulmonary embolism in contrast to the d-dimer testing.