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.

Acute Pulmonary Embolism: Focus on the Clinical Picture

“…Many fatal pulmonary emboli remain unrecognised due to the lack of routine postmortem examinations leading to an underestimation of their incidence. 16) 17) 18) 19) Prompt diagnosis of this potentially deadly disease is of utmost importance, therefore knowledge of the salient features associated with PE may enable physicians to make the diagnosis facilitating the following appropriate treatment strategy.…”