Key result
Negative D-dimer fails to exclude massive bilateral PE in a high-risk acromegaly patient.
Why the study?
While the D-dimer test is useful for excluding pulmonary embolism, it is not infallible.
Case Report (n=1)
No
This case highlights that a negative D-dimer test does not definitively rule out massive pulmonary embolism in high-risk patients, such as those with acromegaly, emphasizing the need for clinical judgment and imaging.
Negative D-dimer warrants caution in high-risk patients such as those with acromegaly; this case leaves open D-dimer performance in endocrine disorders.
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.
No takes yet. Share an insight, caveat, or question.
Al‐Anbagi et al. (2024) conducted a case report in Massive Pulmonary Embolism and Acromegaly (n=1). Low-molecular-weight heparin followed by rivaroxaban was evaluated. A 36-year-old male with acromegaly was diagnosed with a massive bilateral pulmonary embolism despite a negative D-dimer test, demonstrating that D-dimer can be falsely reassuring in high-risk cases.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: