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Pulmonary embolism in severe renal impairment — SCE Acute Medicine MCQ

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ModerateRespiratory medicinePulmonary embolism in severe renal impairmentSCE Acute Medicine

A 62-year-old woman with metastatic ovarian cancer presents with pleuritic chest pain and new hypoxia. She has an eGFR of 18 mL/min/1.73 m2, pulse 116/min and oxygen saturation 92% on 4 L/min oxygen. ECG shows sinus tachycardia and chest radiograph is clear. D-dimer is not helpful because of active cancer. What is the most appropriate investigation?

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Correct answer: D — Ventilation-perfusion SPECT or planar V/Q imaging

In suspected pulmonary embolism with severe renal impairment, V/Q imaging is usually preferred when the chest radiograph is suitable because iodinated contrast may worsen kidney injury. Echocardiography may support management in haemodynamic compromise but does not reliably exclude PE. Leg ultrasound can help if positive, but it is not the best single investigation for a stable patient with a clear radiograph.

Reference: NICE NG158 venous thromboembolic diseases