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Less Is More
January 2015

D-Dimer and the Workup of Pulmonary EmbolismA Teachable Moment

Author Affiliations
  • 1Section of Hospital Medicine, University of Chicago Medical Center, Chicago, Illinois
JAMA Intern Med. 2015;175(1):14-15. doi:10.1001/jamainternmed.2014.5861

Last August, a man in his 50s was taking his usual Sunday morning bike ride when he began to feel light headed and dizzy. Not feeling well enough to make it home, he stopped at a local coffee shop to rest. Within minutes, his dizziness worsened, and he subsequently collapsed while drinking from his water bottle. Emergency medical service was called, and the patient quickly regained consciousness while en route to the hospital.

In the emergency department, the patient reported no recent hospitalizations, surgical procedures, cardiac disease, or history of malignancy. An electrocardiogram showed normal sinus rhythm, and complete blood cell count, basic metabolic panel, and chest radiography results were all normal. A computed tomographic pulmonary angiography (CTPA) was performed, with negative findings for pulmonary embolism (PE), although pulmonary infiltrates were found in the dependent areas of the lung. The findings on CTPA were extensive enough that they were considered a possible cause of the patient’s syncope, and he was admitted for further workup.

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