SUMMARYPulmonary embolism (PE) is a common and life-threatening condition. The British Thoracic Society PE guidelines state that PE is reliably excluded in patients with low-intermediate clinical probability and a negative D-dimer. We are reporting the case of a 47-year-old lady, taking tranexamic acid for menorrhagia, who presented with shortness of breath and was diagnosed with extensive bilateral PE. She had a low clinical risk of PE as determined by her Wells score, and a subsequent negative D-dimer. This patient's D-dimer value of 15 ng/ml (HemosIL DD HS assay) was the lowest associated with any CT pulmonary angiogram (n=1645) recorded at our trust over a 2-year period. This lady was successfully treated with a heparin infusion and warfarin. No further thromboembolic events had occurred by 18-month follow-up. To our knowledge, this is the first case report to describe tranexamic acid causing an extremely low false-negative D-dimer masking PE. BACKGROUND

Highlights Distal pancreatectomy is the surgical operation of choice for cysts located on the body and tail of pancreas. Distal pancreatectomy for pancreatic body cysts can result in loss of healthy distal pancreatic tissue. Central pancreatectomy is an alternative surgical operation of choice of cysts located on pancreatic body. Central pancreatectomy preserves distal healthy pancreas tissue. Distal pancreas tissue can be anastomosed to the stomach when central pancreatectomy is performed.