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Pulmonary embolism in pregnancy — SCE Respiratory MCQ

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HardPulmonary Vascular DiseasePulmonary embolism in pregnancySCE Respiratory

A 36-year-old pregnant woman at 28 weeks has pleuritic pain and dyspnoea. CXR is normal, leg ultrasound is negative and PE remains clinically suspected. Renal function is normal. What is the most appropriate investigation?

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Correct answer: C — Discuss CTPA versus V/Q imaging using local pregnancy pathway

The best answer is “Discuss CTPA versus V/Q imaging using local pregnancy pathway”. Discuss CTPA versus V/Q imaging using local pregnancy pathway is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“D-dimer alone to exclude PE, after specialist assessment”, “defer imaging until after delivery, with clinical reassessment”, “Methacholine challenge, after safety review, within a respiratory pathway”, “Bronchoscopy with lavage, after specialist assessment, after safety review”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1