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Pulmonary embolism in pregnancy — SCE Respiratory MCQ

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HardThoracic ImagingPulmonary embolism in pregnancySCE Respiratory

A 36-year-old woman has acute pleuritic chest pain. CXR is normal. She is 16 weeks pregnant, oxygen saturation is 96% and left calf ultrasound is negative. Clinical suspicion for PE remains high. What is the most appropriate investigation?

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Correct answer: E — CT pulmonary angiography or V/Q imaging after informed discussion of risks

The best answer is “CT pulmonary angiography or V/Q imaging after informed discussion of risks”. CT pulmonary angiography or V/Q imaging after informed discussion of risks 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 principally because pregnancy makes imaging unsuitable, with clinical reassessment”, “Bronchoscopy to exclude endobronchial disease, within a respiratory pathway”, “Repeat CXR in 6 weeks in the absence of anticoagulation, after safety review”, “Exercise ECG as the initial test, after specialist assessment”—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