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Negative D -Dimer With Single-Subsegmental Pulmonary Embolism
Caitlin Burnett1, Michael Koehler
1Author Affiliations: Associated with the Emergency Department, Memorial Health University Medical Center, Savannah, Georgia (Drs Burnett and Koehler).
Advanced Emergency Nursing Journal
|January 9, 2026
Summary
A negative d-dimer test did not rule out pulmonary embolism (PE) in a high-risk patient. Clinical judgment and imaging are crucial for diagnosing PE in emergency departments, especially with prior thromboembolic history.
Area of Science:
- Emergency Medicine
- Cardiology
- Radiology
Background:
- Pulmonary embolism (PE) presents diagnostic challenges in the emergency department (ED) due to nonspecific symptoms.
- A history of cesarean section and prior PE increases patient risk.
- D-dimer testing is commonly used but can be unreliable in certain patient populations.
Purpose of the Study:
- To highlight the importance of clinical judgment in diagnosing PE.
- To emphasize that a negative d-dimer should not exclude PE in high-risk individuals.
- To underscore the role of imaging in confirming PE diagnosis.
Main Methods:
- Case study presentation of a 37-year-old woman with pleuritic chest pain and recent cesarean section.
- Initial d-dimer testing resulted in a negative outcome.
- CT pulmonary angiography was performed due to persistent clinical suspicion.
Main Results:
- CT pulmonary angiography revealed a single-subsegmental PE.
- The negative d-dimer result was misleading in this high-risk patient.
- Outpatient anticoagulation with Eliquis was initiated.
Conclusions:
- Negative d-dimer results should be interpreted cautiously in patients with high-risk factors or prior thromboembolic events.
- Clinical suspicion and diagnostic imaging remain essential for accurate PE diagnosis in the ED.
- Personalized risk stratification and treatment are vital for managing PE.
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