Abeer Berry

Introduction The diagnosis of pulmonary embolism (PE) can be difficult due to variable clinical presentation with symptoms that are often shared with several other disease entities, namely shortness of breath, chest pain, and tachycardia. Laboratory assays are used to help clinicians decide when imaging is required. The d-dimer assay is a commonly used and highly sensitive screening test to assist in the diagnosis of venous thromboembolism (VTE) including deep vein thrombosis and PE.

A 57 year old gentleman with a history of non-ischemic cardiomyopathy and paroxysmal atrial fibrillation presented with worsening lower extremity edema and dyspnea on exertion. He had been compliant with his medications including rivaroxaban (Xarelto) for atrial fibrillation that he takes with the evening meal daily. His echocardiogram showed an ejection fraction of 10-15% and a new left ventricle (LV) apical thrombus. During his hospital stay, he developed right sided weakness.