Progress in Medical Sciences. 2021;
5(1):(44-110)
Pulmonary Embolism in a Patient with Well’s Score of Zero
Zohra R. Malik* and Zareen Razaq
Abstract
Pulmonary embolism is a condition in which a blood clot blocks a vessel in the lungs. It is a
venous thromboembolism that is common and sometimes may prove to be life threatening.
Well’s score/Well’s criteria calculates the risks of developing deep vein thrombosis and
subsequently pulmonary embolism. Well’s score is based on clinical symptoms of DVT (leg
swelling, pain with palpation)(3.0 points each), other diagnosis less likely than pulmonary
embolism (3.0 points each), heart rate more than 100 (1.5 points each), immobilization or
surgery in the last four weeks (1.5 points each), previous DVT/PE (1.5 points each), hemoptysis
(1.0 points), malignancy (1.0 points). If the patient scores 3 or higher there is a high risk of
DVT. 1 or 2 score is a moderate risk of DVT. In patients with moderate or higher probability for
DVT (cut-off scores of 2), the Well’s score was able to detect patients at risk of developing DVT
with a sensitivity of 67% and specificity of 90%. We hereby present a 40-year-old lady with no
significant past medical history, who presented to the emergency department with sudden
onset of non-radiating right sided chest pain and shortness of breath worsened with walking.
Patient denied smoking, recent travels, OCP, recent surgeries, immobilization, previous DVT,
pulmonary embolism, hemoptysis, malignancy, miscarriages, lupus. No family history of
coagulopathies. Vitals were stable with Blood pressure of 101/60 mmHg, heart rate of 77
beats/minute, afebrile, Respiratory rate of 18, saturating 99% on room air. On examination
no leg swelling or tenderness noted, no Intercostal Retraction, no use of accessory muscles,
lungs clear to auscultation bilaterally. Venous Doppler study was unremarkable. Chest x
ray did not show any cardio-pulmonary disease. The Well’s score came out to be zero with
pulmonary embolism very low in the differential. We decided to do CT chest which showed
small pulmonary emboli involving bilateral lower lobe sub-segmental pulmonary arteries.
D-dimer came out to be 1938. All the rest of the labs and the coagulation factors were within
normal limits. We started the patient on lovenox subQ 60 mg Q12 hourly with improvement in
the shortness of breath. Patient was discharged on Xarelto. The possibility of DVT should still
be considered if the patient presents with shortness of breath with zero Well’s Score.
