DOI: 10.12890/2025_005851
The diagnosis of pulmonary embolism despite a negative D-dimer assay: the importance of individualised clinical assessment and other investigations
Authors
connor.thompson9@nhs.net
Keywords
Pulmonary embolism, D-dimer, wells score, X-ray, Hampton’s humpAbstract
Pulmonary embolism is an important differential diagnosis in the work up of patients presenting with chest pain and respiratory symptoms. Left untreated, it carries a high mortality. Pulmonary embolism presents a diagnostic challenge as the clinical presentation varies widely. Hospitals in the United Kingdom frequently use the validated D-dimer assay as an initial ‘rule-out’ test for low-risk patients. We present the case of a 69-year-old woman, presenting with chest pain and cough. She was deemed low-risk for pulmonary embolism using validated scoring systems and had a negative D-dimer assay, however clinical suspicion and chest X-ray findings lead to further investigation with computed tomography pulmonary angiography. This revealed a suspected pulmonary infarct, and the diagnosis of pulmonary embolism was made. This report highlights that while the D-dimer assay and Wells score are useful tools in the work-up for pulmonary embolism, they should not replace careful clinical assessment. We also explore X-ray findings pertinent to this case and their association with pulmonary embolism.
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