History of Present Illness

A woman in her mid-40s presents to the emergency department with a 3-day history of pleuritic-like chest pain on the left side with accompanying shortness of breath, nausea, and loss of appetite. The patient denies abdominal pain, fever, or diarrhea. She recently returned from a Caribbean vacation. She reports having COVID-19 approximately 1 month earlier, which entailed 3 days of mild symptoms.

Vital Signs and Physical Examination

The patient’s vital signs and physical examination in the emergency department are normal. Laboratory tests are normal including liver function test and lipase. Urinalysis is normal and a β-hCG pregnancy test is negative. The only abnormal finding is an elevated dimerized plasma fragment D (D-dimer) level of greater than 1000 ng/mL.

A computed tomography (CT) scan is ordered (Figure), which is negative for pulmonary embolism.

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