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Identification of Disease-related Spatial Covariance Patterns using Neuroimaging Data
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Assembling the Puzzle: Taking into Account Clinical Presentation and Predictive Scores.

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Summary

This case highlights that pulmonary embolism can present as syncope, even with a low Wells score. High clinical suspicion and diagnostic testing are crucial for identifying rare but life-threatening causes of fainting.

Keywords:
Predictive ScorePulmonary EmbolismPulmonary embolism rule-out criteriaSyncopeWell’s Score

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Pulmonology

Background:

  • Syncope is a frequent reason for emergency department visits, necessitating prompt evaluation for potentially fatal etiologies.
  • Clinical decision rules aid in risk stratification and guide diagnostic pathways for syncope patients.

Observation:

  • An 83-year-old male presented with a 5-minute episode of syncope and hypotension.
  • Physical examination was unremarkable, and the Wells score was 0, typically indicating a low probability of pulmonary embolism.

Findings:

  • Despite a low Wells score, persistent clinical suspicion for pulmonary embolism led to further testing.
  • Elevated D-dimer (13.77 mcg/mL) and computed tomography angiography revealed extensive bilateral pulmonary embolism.
  • The patient was initiated on full-dose anticoagulation therapy.

Implications:

  • This case underscores the importance of maintaining high clinical suspicion for uncommon causes of syncope, such as pulmonary embolism.
  • It emphasizes the value of integrating predictive scoring tools with clinical judgment in diagnosing critical conditions.
  • Accurate diagnosis and timely management of pulmonary embolism are vital to prevent patient morbidity and mortality.