Pulmonary Embolism Work-up

Today we had a great case of right shoulder pain that after the history was likely referred pain.  We talked about some great points including the work-up for PE.

1.        Today reviewed the work-up for a suspected PE and specifically the Annals 2015 guidelines.  First use the Wells criteria, the Geneva score or gestalt (if you are an expert), to classify people as low, intermediate or high risk of PE.  See the below algorithm for continued work-up. 

2.       In patient’s over the age of 50 y/o an age adjusted D-Dimer cut-off should be used as it maintains sensitivity and increases specificity.  To calculate the age adjusted cut-off use the following equation:   Age x 10 = D-Dimer ug/L cut-off. 

3.       Fibrolamellar Hepatocellular Carcinoma is a very rare form of HCC that affects young adults.  It is slowly progressive and not associated with pre-existing liver disease.