Massive Pulmonary Embolism With Negative D-dimer: A Case Report

Pulmonary embolism (PE) is a critical condition that arises when clots migrate to the lungs, obstructing pulmonary circulation and posing a significant risk to the patient's health. While the D-dimer test is useful for excluding PE, it is not infallible. This report describes a case where extensive PE was present despite the patient having a normal D-dimer level, emphasizing the importance of a thorough clinical evaluation. Our case is that of a 36-year-old male patient with a known history of acromegaly. He presented to the emergency department with a cough, shortness of breath, and high-grade fever and was ultimately diagnosed with a massive bilateral PE. Despite a negative D-dimer result and a low probability based on the Wells score, the diagnosis was confirmed by a CT pulmonary angiogram. This case report raises questions about the sensitivity and safety of a negative D-dimer result in ruling out acute PE. Clinical judgment, combined with imaging, is essential for an accurate diagnosis in high-risk cases to avoid missing life-threatening conditions like PE.