A patient with a large pulmonary saddle embolus eluding both clinical gestalt and validated decision rules

Adam Hennessey; Devy A Setyono; Wayne Bond Lau; Jason Matthew Fields

doi:10.1016/j.annemergmed.2011.11.016

A patient with a large pulmonary saddle embolus eluding both clinical gestalt and validated decision rules

Ann Emerg Med. 2012 Jun;59(6):521-3. doi: 10.1016/j.annemergmed.2011.11.016. Epub 2011 Dec 9.

Authors

Adam Hennessey¹, Devy A Setyono, Wayne Bond Lau, Jason Matthew Fields

Affiliation

¹ Thomas Jefferson University Hospital, Department of Emergency Medicine, Philadelphia, PA, USA. ahennessey@gmail.com

PMID: 22153968
DOI: 10.1016/j.annemergmed.2011.11.016

Abstract

We report a patient with chest pain who was classified as having low risk for pulmonary embolism with clinical gestalt and accepted clinical decision rules. An inadvertently ordered D-dimer and abnormal result, however, led to the identification of a large saddle embolus. This case illustrates the fallibility of even well-validated decision aids and that an embolism missed by these tools is not necessarily low risk or indicative of a low clot burden.

Publication types

Case Reports

MeSH terms

Adult
Decision Support Techniques
Emergency Service, Hospital
Female
Fibrin Fibrinogen Degradation Products / analysis
Gestalt Theory
Humans
Pulmonary Embolism / blood
Pulmonary Embolism / diagnosis*
Pulmonary Embolism / diagnostic imaging
Tomography, X-Ray Computed

Substances

Fibrin Fibrinogen Degradation Products
fibrin fragment D