A 68-year-old with pleuritic chest pain and dyspnea has a Wells score of 1.5 (low probability). A highly sensitive D-dimer (reported in FEU) returns 5...

Question

A 68-year-old with pleuritic chest pain and dyspnea has a Wells score of 1.5 (low probability). A highly sensitive D-dimer (reported in FEU) returns 520 ng/mL. What is the best next step?

Accepted Answer

Use age-adjusted D-dimer (age × 10 ng/mL FEU); at a cutoff of 680 ng/mL, this result rules out PE without imaging.

Answer

Order CT pulmonary angiography because any D-dimer above 500 ng/mL is positive in older adults.

Answer

Start full-dose anticoagulation while arranging imaging.

Answer

Use PERC to rule out PE and discharge.

Answer

Repeat the D-dimer in 24 hours.

Pulmonary Embolism — MRCEM SBA MCQ

A 68-year-old with pleuritic chest pain and dyspnea has a Wells score of 1.5 (low probability). A highly sensitive D-dimer (reported in FEU) returns 520 ng/mL. What is the best next step?