A 45-year-old female presents to the emergency department with sudden onset of shortness of breath and chest pain. She recently underwent a long flight and has a history of oral contraceptive use. Which of the following is the most appropriate initial diagnostic test for suspected pulmonary embolism?
CT pulmonary angiography
Chest X-ray
Echocardiography
D-dimer test
The most appropriate initial diagnostic test for suspected pulmonary embolism is a D-dimer test. D-dimer is a fibrin degradation product that is elevated in the presence of blood clots. It has a high sensitivity but low specificity for pulmonary embolism. A negative D-dimer test can effectively rule out pulmonary embolism in patients with low to moderate clinical probability, while a positive result warrants further imaging studies.
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, but it is not typically the initial test due to radiation exposure and potential contrast-related complications. Chest X-ray may show nonspecific findings but cannot definitively diagnose or rule out pulmonary embolism. Echocardiography can be useful in assessing right ventricular function and identifying signs of right heart strain, but it is not the initial diagnostic test of choice for suspected pulmonary embolism.
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