• Vol. 35 No. 12, 858–863
  • 15 December 2006

Use of D-dimer and Lower Extremity Doppler Ultrasound Results to Obviate the Need for Computerised Tomographic Pulmonary Angiography

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ABSTRACT

Introduction: We hypothesise that correct interpretation of other diagnostic tests could reduce the use of computerised tomographic pulmonary angiogram (CTPA) examinations in patients with suspected pulmonary embolism (PE).

Materials and Methods: We carried out a retrospective analysis of 158 patients in a 928-bed university hospital. These consecutive patients were investigated for suspected PE from May 2001 to February 2002 using CTPA.

Results: There were 74 men and 84 women with a mean (±SD) age of 57 (±19) years. Overall, 56% of patients (89/158) showed clinically significant abnormalities on the CTPA examination. The overall prevalence of PE was 15% (24/158). The D-dimers were assayed in 40% (63/158) and lower limbs were scanned with Doppler ultrasound (US) in 22% (35/158) of patients. None of the 19 patients with negative D-dimer assays had PE. Of the patients who were positively tested on Doppler US, 4 were positive and 1 was negative for PE on the CTPA. None of the patients with positive Doppler US had negative D-dimer test. In retrospect, patient management based on negative D-dimer assays and positive lower extremity Doppler US studies could have reduced the need for further investigation with CTPA by 15% (24/158).

Conclusion: In patients with suspected PE, correct interpretation of D-dimer and leg Doppler US tests may reduce the demand for CTPAs.


The diagnosis of pulmonary embolism (PE) can be a challenging problem. It depends on clinical suspicion and the interpretation of a combination of clinical and radiological presentations.

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