Al-Anbagi Usamah, Saad Abdulrahman, Ibrahim Tarek, Nashwan Abdulqadir J
Internal Medicine, Hamad Medical Corporation, Doha, QAT.
Medicine, Ministry of Public Health, Doha, QAT.
Cureus. 2024 Dec 23;16(12):e76270. doi: 10.7759/cureus.76270. eCollection 2024 Dec.
Pulmonary embolism (PE) is a critical condition that arises when clots migrate to the lungs, obstructing pulmonary circulation and posing a significant risk to the patient's health. While the D-dimer test is useful for excluding PE, it is not infallible. This report describes a case where extensive PE was present despite the patient having a normal D-dimer level, emphasizing the importance of a thorough clinical evaluation. Our case is that of a 36-year-old male patient with a known history of acromegaly. He presented to the emergency department with a cough, shortness of breath, and high-grade fever and was ultimately diagnosed with a massive bilateral PE. Despite a negative D-dimer result and a low probability based on the Wells score, the diagnosis was confirmed by a CT pulmonary angiogram. This case report raises questions about the sensitivity and safety of a negative D-dimer result in ruling out acute PE. Clinical judgment, combined with imaging, is essential for an accurate diagnosis in high-risk cases to avoid missing life-threatening conditions like PE.
肺栓塞（PE）是一种危急病症，当血栓转移至肺部，阻塞肺循环并对患者健康构成重大风险时就会出现。虽然D - 二聚体检测有助于排除肺栓塞，但并非万无一失。本报告描述了一例尽管患者D - 二聚体水平正常但仍存在广泛肺栓塞的病例，强调了全面临床评估的重要性。我们的病例是一名36岁的男性患者，有肢端肥大症病史。他因咳嗽、呼吸急促和高热就诊于急诊科，最终被诊断为大面积双侧肺栓塞。尽管D - 二聚体结果为阴性且根据Wells评分概率较低，但通过CT肺动脉造影确诊了该诊断。本病例报告引发了关于阴性D - 二聚体结果在排除急性肺栓塞方面的敏感性和安全性的问题。在高危病例中，临床判断与影像学检查相结合对于准确诊断至关重要，以避免漏诊像肺栓塞这样危及生命的病症。
