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Abnormal d-dimers, CT and chest x-ray normal. What can all this indicate?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
I am 36 years old female. Two recent abnormal d dimers, normal ct of chest normal chest xray nothing found on doppler done on legs, ekg normal. blood count normal. otherwise healthy. Esr 45. what can all this indicate? also found out have heart murmor and some type of diastolic dysfunction
Posted Wed, 2 May 2012 in Lung and Chest disorders
Answered by Dr. Raja Sekhar Varma 4 hours later

Thank you for your query.

I would like to know some more details from you so that I can give you a more specific answer?

1) What are your symptoms? What prompted you to do all these tests?
2) Is there any swelling of the feet?
3) Is there any breathlessness?
4) Have you had any fever or any other infection?
5) Please scan and upload the ECG here.
6) Please upload the complete report of the echo of the heart. If echo has not been done, please get it performed.

D-dimer can be positive in many conditions, the most important being pulmonary thrombo-embolism and any infection/inflammation. The clinical scenario is necessary to interpret the results.

Since you are over the age of 35 years and since the d-dimer is abnormal, I would suggest that you switch over to an alternate form of contraception. Birth control pills over the age of 35 years may be associated with an increase incidence of pulmonary thrombo-embolism.

The evaluation of a heart murmur necessitates an echo of the heart. Diastolic dysfunction is an impairment of the relaxation of the heart after each pumping effort. There may be many causes and the significance is dependent on the clinical condition and the other echo findings.

Kindly get back to me with answers to the aforementioned questions, so that I can give you a more useful and specific reply.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Abnormal d-dimers, CT and chest x-ray normal. What can all this indicate? 3 days later
To answer your questions...
1. Within the last 12 months I have felt tired more easily, sweat more easily periodically, lightheaded sometimes, and some leg cramps. I had a pap and breast exam results all normal. I went to see Dr she identified heart murmur and ordered heart ultrasound. My hormone levels, iron, blood count, blood pressure, and all other tests were normal. One night I started having some pains just below my left breast and a little trouble breathing. Went to ER. Chest xray was ok, EKG was ok, but D Dimer was abnormal so they did ct scan on my chest area. They found nothing, and sent me home saying must be stress related. Dr ordered follow up d dimer a week later and still abnormal. Also had venous doppler done on leg area and found nothing wrong. Dr ordered coagulation and ESR test. Coag was fine, but ESr was 45 and she said it should be 20. She is referring me to a Hemmatologist. I havenot received any copies of the tests done so far. I have been healthy my life. Never smoked and occasional drink. No broken bones, stitches, diseases, etc.. I had a normal vaginal delivery 2008 with no complications and another one in 2009. Both very healthy girls. I am a Licensed Marriage and Family therapist, but have been a stay at home mom since Aug 2008. My parents are still living. My father has recovered from prostate cancer and is otherwise healthy, my mother has fibromyalgia and has had panic attacks and anxiety. My brother is in perfect health. My MGM had congestive heart disease, but died in her 80's due to complications from Alzheimers. My MGF is still alive but has had strokes and heart attacks. My PGF died from cancer and so did my PGM they both were alcoholics and smokers. This past Thanksgiving I had Strep throat and took amoxicillin, and healed within a week. I have had some spider veins in my legs since my early 20's and I have gained weight over the past 2 years. I have no swelling. I do have two spots that often itch a lot although there is no dry skin or rash there. One is on my upper inside thigh the other on the back of my neck. I will stop the BC pills. I had been taking the BC pills that were safe to take while nursing baby, but recently (3 months ago) switched to normal BC pills.
Answered by Dr. Raja Sekhar Varma 6 hours later
Thank you for the detailed reply.

The D-dimer test was done with the intention of screening for any evidence of pulmonary thrombo-embolism. This occurs when blood clots in any XXXXXXX vein and bits of the clot break free and get transported through the right side of the heart to the blood vessels of the lungs. Such episodes can cause chest discomfort and breathing difficulty. If the clot is massive, there could be a fall in the blood pressure and this can even be fatal sometimes.
However, it appears that in your case, though the D-dimer is abnormal, there is no other evidence to support a diagnosis of pulmonary embolism. It is relevant to note that D-dimer can be positive in the presence of many conditions that cause infection or inflammation, and whenever there is breakdown of even small blood clots. If you take the elevated ESR and the throat infection into account, you could probably explain the abnormal D-dimer test.
Your hematologist will help to identify any other causes of an elevated ESR (other than any infection).
My advice in the previous post regarding the contraceptive pills still holds. You can switch over to any other form of contraception, after consulting your obstetrician.
I hope this answers your query. Please accept my answer if there are no further clarifications needed.
I wish you all the best for a happy and healthy life.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Abnormal d-dimers, CT and chest x-ray normal. What can all this indicate? 11 hours later
Thankyou for your reply. So, will I need just to wait to see why the ESR is so high then? What are possible reasons for the ESR so high?

Also, I received my copy of the echocardiogram today. I do not have a scanner but it says the following:
Echocardiogram (M-Mode @D Spectral and color doppler)
!. Normal left ventricular chamber size, wall thickness, and contractility. Ejection fraction normal at 60%.
2.Normal appearing trileaflet aortic valve without significant insufficiency or stenosis.
3. Normal appearing mitral valve leaflets with minimal mitral regurgitation, but no significant prolapse.
4.Mild tricuspid regurgitation without significant pulmonary hypertension.
5.Mild left atrial enlargement. No other significant chamber enlargement seen.
6. No significant pericardial effusion.
7. No intracardiac thrombus or masses seen.
8. Normal right heart chamber size and contractility.
9. Diastolic dysfunction and abnormal relaxation on Doppler imaging.
10. Normal E/E ratio consistent with normal left atrial pressure.
11. Small caliber inferior vena cava with normal respiratory variation consistent with low right atrial pressure.

What does all this mean? Especially #9?

Also, in the last 3 days, throughout the day I am experiencing weird, mild discomfort sensations all over my body. It is like slight pings in a small area for a few seconds that are uncomfortable, but then gone. However, I have felt these "pings" in most areas of my body at some point during the last few days. What is going on?Is my blood not working right or my veins or heart having problems? it is only a pain level 3 for me, but is very annoying.

Answered by Dr. Raja Sekhar Varma 15 hours later
Thank you for the query.

The most common reason for an elevated ESR is any infection or inflammation. Other causes include certain types of anemias, some hematological disorders, joint disorders, rheumatic problems, etc.

The echo findings are more or less normal. Diastolic dysfunction, referred to in #9, is an impairment in the relaxation of the heart muscle after each muscular contraction in pumping blood. If there is no increase in the thickness of the muscles and if there are no other co-existing problems, this may just be an incidental finding. I note that the left atrial pressure estimated by the E/E' ratio is normal. This would have been elevated if there is any functional significance of the diastolic dysfunction.

I would ask you to check your blood pressure regularly and ensure that it is within normal limits. A higher than normal BP is a common cause for diastolic dysfunction.

The 'pings' that you feel all over the body are most unlikely to be due to cardiac problems. They could be just a reflection of some stress/anxiety or may even be due to some electrolyte imbalance or vitamin deficiencies. You could consult your general physician for the relevant clinical examination to determine the exact cause.

I hope this answers your query. Please accept my answer if you do not need any further clarifications. Please accept my answer in case you have no follow up queries.

With regards,
Dr RS Varma
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