{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T14:09:57Z","timestamp":1762524597342,"version":"build-2065373602"},"reference-count":10,"publisher":"SMC Media","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Pulmonary embolism is an important differential diagnosis in the work up of patients presenting with chest pain and respiratory symptoms. Left untreated, it carries a high mortality. Pulmonary embolism presents a diagnostic challenge as the clinical presentation varies widely. Hospitals in the United Kingdom frequently use the validated D-dimer assay as an initial \u2018rule-out\u2019 test for low-risk patients. We present the case of a 69-year-old woman, presenting with chest pain and cough. She was deemed low-risk for pulmonary embolism using validated scoring systems and had a negative D-dimer assay, however clinical suspicion and chest X-ray findings lead to further investigation with computed tomography pulmonary angiography. This revealed a suspected pulmonary infarct, and the diagnosis of pulmonary embolism was made. This report highlights that while the D-dimer assay and Wells score are useful tools in the work-up for pulmonary embolism, they should not replace careful clinical assessment. We also explore X-ray findings pertinent to this case and their association with pulmonary embolism.<\/jats:p>","DOI":"10.12890\/2025_005851","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:14:22Z","timestamp":1760955262000},"source":"Crossref","is-referenced-by-count":0,"title":["The diagnosis of pulmonary embolism despite a negative D-dimer assay: the importance of individualised clinical assessment and other investigations"],"prefix":"10.12890","volume":"12","author":[{"given":"Connor","family":"Thompson","sequence":"first","affiliation":[{"name":"General Medicine, Northumbria Specialist Emergency Care Hospital, Cramlington, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"10.12890\/2025_005851_ref1","unstructured":"https:\/\/digital.nhs.uk [Internet]. Hospital Admitted Patient Care Activity, 2023-24. 26th September 2024. Available from Hospital Admitted Patient Care Activity, 2023-24 - NHS England Digital."},{"key":"10.12890\/2025_005851_ref2","unstructured":"Belohlavek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol 2013;18:129-138."},{"key":"10.12890\/2025_005851_ref3","doi-asserted-by":"crossref","unstructured":"Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997-1005. doi: 10.7326\/0003-4819-129-12-199812150-00002","DOI":"10.7326\/0003-4819-129-12-199812150-00002"},{"key":"10.12890\/2025_005851_ref4","doi-asserted-by":"crossref","unstructured":"Van Belle A, B\u00fcller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172-179. doi: 10.1001\/jama.295.2.172","DOI":"10.1001\/jama.295.2.172"},{"key":"10.12890\/2025_005851_ref5","doi-asserted-by":"crossref","unstructured":"Breen ME, Dorfman M, Chan SB. Pulmonary embolism despite negative ELISA D-dimer: a case report. J Emerg Med 2009;37:290-292. doi: 10.1016\/j.jemermed.2007","DOI":"10.1016\/j.jemermed.2007.11.028"},{"key":"10.12890\/2025_005851_ref6","doi-asserted-by":"crossref","unstructured":"Alsararatee HH. Novel insights into pulmonary embolism with negative D-dimer results. BMJ Case Rep 2025;18:e264995. doi: 10.1136\/bcr-2025-264995","DOI":"10.1136\/bcr-2025-264995"},{"key":"10.12890\/2025_005851_ref7","doi-asserted-by":"crossref","unstructured":"West J, Goodacre S, Sampson F. The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis. QJM 2007;100:763-769. doi: 10.1093\/qjmed\/hcm113","DOI":"10.1093\/qjmed\/hcm113"},{"key":"10.12890\/2025_005851_ref8","doi-asserted-by":"crossref","unstructured":"Elliot CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. Chest 2000;118:33-38.doi: 10.1378\/chest.118.1.33","DOI":"10.1378\/chest.118.1.33"},{"key":"10.12890\/2025_005851_ref9","doi-asserted-by":"crossref","unstructured":"Kubiak K, Bazylewicz-Zakrzewska K, Poncyljusz W. Hampton\u2019s Hump\u2014A Rare Radiological Feature in Patients with Pulmonary Embolism in a Single-Center Study. J Clin Med 2025;14:1900. doi: 10.3390\/jcm14061900","DOI":"10.3390\/jcm14061900"},{"key":"10.12890\/2025_005851_ref10","doi-asserted-by":"crossref","unstructured":"Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993;189:133-136. doi: 10.1148\/radiology.189.1.8372182","DOI":"10.1148\/radiology.189.1.8372182"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5851\/4905","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5851\/4906","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5851\/4906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T14:05:05Z","timestamp":1762524305000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/5851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":10,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.12890\/2025_005851","relation":{"has-manifestation":[{"id-type":"other","id":"1-131-5851-g4905","asserted-by":"subject"},{"id-type":"other","id":"1-131-5851-g4906","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-131","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2025,10,20]]}}}