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Salvatore Massimo Petrina: High D-Dimer, Negative CT Scan – What’s Your Next Move?

Salvatore Massimo Petrina/reumamedica.it

Dec 21, 2025, 15:19

Salvatore Massimo Petrina: High D-Dimer, Negative CT Scan – What’s Your Next Move?

Salvatore Massimo Petrina, Hospital Physician Cardiology ASP Ragusa, shared on LinkedIn:

”Title: High D-Dimer, Negative CT Scan: What’s Your Next Move?

It’s a scenario every clinician knows well: a patient has a high D-dimer, you order a CT to rule out PE, and the scan comes back negative.

Do you discharge the patient and breathe a sigh of relief?

Not so fast.

A negative CT is a crucial data point, but it’s not always the end of the diagnostic journey.

A high D-dimer is a non-specific marker of coagulation activation, and we have a responsibility to investigate further.

This guide provides an excellent 3-phase framework for navigating this clinical puzzle:

Phase 1: Rule Out Other Vascular Risks

Before moving on, double-check for other life-threatening conditions that could have been missed or present concurrently.

Aortic Dissection: A critical can’t-miss diagnosis.

Deep Vein Thrombosis (DVT): Was a DVT ruled out, or was the focus solely on the PE?

Other VTE Events: Consider less common thrombotic events.

Phase 2: Search for Inflammation and Injury

The D-dimer is often elevated due to significant systemic stress.

It’s time to broaden the differential.

Infection/Sepsis: A very common cause of high D-dimer levels.

Occult Malignancy: Always consider this, especially in patients with no prior history.

Covert Bleeding or Trauma: Look for internal bleeding or injuries that aren’t immediately obvious.

Phase 3: Adjust for Baseline and Systemic Factors

Sometimes, the high D-dimer reflects the patient’s chronic state rather than an acute event.

Chronic Inflammation: Conditions like rheumatoid arthritis or IBD.

Systemic Coagulopathies: Underlying clotting disorders.

Patient-Specific Factors: Advanced age or post-surgical state can keep levels elevated.

The key takeaway: A high D-dimer is a signal to keep looking.

A systematic approach ensures we don’t stop our search prematurely and provide the best care for our patients.