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Related Concept Videos

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
Pulmonary Embolism I: Introduction01:19

Pulmonary Embolism I: Introduction

A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...
Pulmonary Embolism I: Introduction01:29

Pulmonary Embolism I: Introduction

Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
Pulmonary Embolism III: Nursing Management01:27

Pulmonary Embolism III: Nursing Management

A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
Radiological Investigation III: Pulmonary Angiogram and PET Scan01:13

Radiological Investigation III: Pulmonary Angiogram and PET Scan

Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
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Related Experiment Video

Updated: May 25, 2026

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
10:26

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Published on: June 2, 2015

D-dimer threshold increase with pretest probability unlikely for pulmonary embolism to decrease unnecessary

J A Kline1, M M Hogg, D M Courtney

  • 1Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA. jkline@carolinas.org

Journal of Thrombosis and Haemostasis : JTH
|January 31, 2012
PubMed
Summary
This summary is machine-generated.

Doubling the D-dimer threshold for suspected pulmonary embolism (PE) can reduce computed tomographic pulmonary angiography (CTPA) scans. This approach slightly increases the risk of missing subsegmental PE but does not affect pneumonia diagnosis rates.

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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
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Published on: August 9, 2024

Area of Science:

  • Medical Diagnostics
  • Radiology
  • Clinical Pathology

Background:

  • Elevating D-dimer thresholds may decrease unnecessary computed tomographic pulmonary angiography (CTPA) for suspected pulmonary embolism (PE).
  • However, this strategy could potentially increase the rates of missed PE and pneumonia, a common non-thromboembolic finding on CTPA.

Purpose of the Study:

  • To evaluate the impact of doubling the standard D-dimer threshold on the exclusion rate of PE.
  • To assess the frequency and size of missed PE and pneumonia when using an elevated D-dimer threshold in patients with low pretest probability (Revised Geneva or Wells' scores).

Main Methods:

  • Prospective enrollment of 678 patients undergoing CTPA for suspected PE across four hospitals.
  • Real-time collection of pretest probability data and central laboratory D-dimer measurement.
  • Diagnosis confirmed by dual radiologist interpretation of CTPA and 30-day clinical outcome.

Main Results:

  • Using an elevated D-dimer threshold (< 1000 ng mL(-1)) with a Revised Geneva Score ≤ 6 identified more patients with negative D-dimer (31%) compared to the standard threshold (16%).
  • This resulted in 5.3% of patients having a missed PE, predominantly subsegmental, with no concurrent deep vein thrombosis (DVT).
  • The rate of missed pneumonia remained similar (5.4%) with the elevated threshold.

Conclusions:

  • Doubling the D-dimer threshold in patients with unlikely PE pretest probability can reduce CTPA utilization.
  • This strategy presents a slightly increased risk of missing isolated subsegmental PE but does not elevate the rate of missed pneumonia.