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[Deep-vein thrombosis despite a low D-Dimer level].

P Manckoundia1, P Pfitzenmeyer

  • 1Service de médecine interne gériatrique, hôpital de Champmaillot, CHU, 2, rue Jules-Violle, BP 87909, 21079 Dijon cedex, France. patrick.manckoundia@chu-dijon.fr

Journal Des Maladies Vasculaires
|September 28, 2007
PubMed
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A case study highlights that a low D-Dimer level may not always rule out deep-vein thrombosis (DVT). Careful interpretation of D-Dimer test results is crucial for accurate DVT diagnosis.

Area of Science:

  • Medical Diagnostics
  • Vascular Medicine
  • Clinical Case Studies

Background:

  • Deep-vein thrombosis (DVT) is a prevalent vascular condition often presenting diagnostic challenges.
  • The D-Dimer blood test is commonly used to exclude DVT, with levels below a reference threshold generally considered negative.
  • This approach relies on the assumption that elevated D-Dimer levels are consistently associated with the presence of thrombosis.

Observation:

  • An 89-year-old male patient presented with a 5-day history of left lower leg pain.
  • Despite the presenting symptoms suggestive of DVT, the patient's serum D-Dimer level was below the established reference threshold of 220 UI/ml upon admission.
  • This presented a potential discrepancy between clinical suspicion and laboratory findings.

Findings:

Related Experiment Videos

  • Venous duplex ultrasound, a key imaging modality for DVT diagnosis, revealed the presence of two recent deep-vein thrombi in the patient's left lower leg.
  • This finding directly contradicted the expectation based on the low D-Dimer level, indicating a false-negative or misleading result from the D-Dimer assay in this specific clinical context.

Implications:

  • This case underscores the critical need for judicious interpretation of D-Dimer levels in the diagnostic workup of suspected deep-vein thrombosis.
  • It suggests that clinical judgment and complementary diagnostic tools, such as ultrasound, remain indispensable, especially in elderly patients or those with atypical presentations.
  • The findings prompt a re-evaluation of the universal applicability of the D-Dimer cutoff value for ruling out DVT in all patient populations.