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Pulmonary embolism in pregnancy — RACP Adult Medicine MCQ

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HardRespiratoryPulmonary embolism in pregnancyRACP Adult Medicine

A 31-year-old woman at 24 weeks gestation develops pleuritic chest pain and dyspnoea. Heart rate is 116/min, oxygen saturation is 94% on air, and the chest radiograph is normal. Compression ultrasound of both legs shows no DVT. Clinical suspicion for pulmonary embolism remains high. What is the most appropriate investigation?

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Correct answer: D — Ventilation-perfusion scan or CTPA selected after local pregnancy imaging protocol discussion

When PE remains suspected in pregnancy after negative leg ultrasound, thoracic imaging is required; V/Q or CTPA is selected using local protocols and patient-specific radiation considerations. D-dimer alone is not sufficient in high suspicion. Deferring imaging, stress testing or bronchoscopy risks missing a potentially fatal diagnosis.

Reference: RANZCOG/TSANZ pregnancy PE guidance; Therapeutic Guidelines (eTG)