Differential diagnosis and investigations
Up to this point, we have made a diagnosis of massive PE clinically on
the basis of her modified well’s score of 5.5 (HR>100,
Hemoptysis as well as no alternative diagnoses more likely than PE) in
addition to the hemodynamic instability that our patient has suffered
from which cannot be explained by any cardiac condition (given her
normal cardiac exam and normal echocardiography excluding cardiac causes
of her hemodynamic instability). A very high level of d-dimer (10000)
has supported that diagnosis. Nevertheless, we were not able to do the
CT pulmonary angiography scan of the chest due to financial and logistic
causes as well as the patient’s hemodynamic instability. A transthoracic
echography was normal ruling out cardiac causes of possible
presentation.