Clinical Case Database / Category: Patient Management

A case of D-Dimer negative pulmonary embolism

Publication details

Dr Lawrence LM Li, Dr Brodie Paterson
Foundation Years Journal, volume 3, issue 10, p.41 (123Doc Education, London, December 2009)


Pulmonary embolism (PE) presents a diagnostic challenge for the emergency physician. Undiagnosed PE is associated with a mortality of up to 30% although more recent data suggests a lower mortality rate (1). The advent of D-dimer testing looked to bring a sensitive “rule-out” test to EM. Reviews have shown the D-dimer testing is only accurate in the low-risk group (2). This article highlights a case of a patient who despite having clinical signs of a pulmonary embolism had their diagnosis delayed due to a negative D-dimer result.

In conclusion it should be remembered that D-dimers are not sensitive enough to rule out PE in patients at high risk. Although the use of D-dimers initially promised to be very useful in ruling out PE subsequent reviews have suggested it is only accurate in low-risk patients.

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Dr Lawrence LM Li

Department of Accident and Emergency
Ninewells Hospital

Dr Brodie Paterson

Department of Accident and Emergency
Ninewells Hospital


1.  Calder KK, Herbert M, Henderson SO (2005) The mortality of untreated pulmonary embolism in Emergency Department patients. Annals of Emergency Medicine, 45: 302–310.

2.  British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group (2003) British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax,58: 470–484.

3.  Gardiner C, Pennaneac’h C, Walford C, et al. (2005) An evaluation of rapid D-dimer assays for the exclusion of deep vein thrombosis. British Journal of Haematology, 128(6): 842–848.

4.  Wells PS, Ginsberg JS, Anderson DR, et al. (1998) Use of a clinical model for safe management of patients with suspected pulmonary embolism. Annals of Internal Medicine, 129: 997–1005.

5.  Wells PS, Anderson DR, Roger MA, et al. (2001) Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the Emergency Department by using a simple clinical model and D-dimer. Annals of Internal Medicine, 135: 98–107.

6.  Breen ME, Dorfman M, Chan SB. Pulmonary embolism despite negative ELISA D-dimer: A case report. The Journal of Emergency Medicine, doi:10.1016/j. jemermed.2007.11.028.


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