A 40-year-old female with a history of lupus presents with acute dyspnea and chest pain. She also reports calf pain and swelling. On physical exam, she has decreased breath sounds on the left side. Her D-dimer is elevated. What are the next steps?
The patient's symptoms and findings, coupled with an elevated D-dimer, are concerning for a pulmonary embolism, potentially resulting from a deep vein thrombosis (the likely source of her calf pain and swelling). Systemic lupus erythematosus is also a known risk factor for thromboembolic events. The next steps should include immediate anticoagulation, unless contraindicated, and diagnostic imaging, most likely a CT pulmonary angiogram to confirm the diagnosis.