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.