Diagnosis of pulmonary thromboembolism (PTE) usually includes clinical pretest probability assessment, testing for specific degradation prod­ucts of cross-linked fibrin (D-dimer) and imaging studies. Patients with radiological findings attribut­able to pulmonary infarction and normal D-dimer level, may present a diagnostic and therapeutic challenge. A 37-year-old Caucasian female had episodes of hemoptysis, and bilateral pulmonary nodular infiltrates on chest radiograph and comput­erized tomography. The plasma D-dimer level was normal, perfusion lung scan was not conclusive and histological examination of an open lung biopsy revealed recent thrombotic pulmonary infarction. She deteriorated and more perfusion defects were detected on perfusion lung scan. Genetic analysis revealed her to be a carrier of the prothrombin fac­tor II (FII) G20210A mutation.

Key words: Surgical procedure, Thromboem­bolism, Cross-linked fibrin (D-dimer), Factor II (FII) G20210A mutation, Risk factor

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Department of Internal Medicine, School of Medi­cine, University of Belgrade, Belgrade, Serbia Institute of Lung Diseases and Tuberculosis, Clini­cal Centre of Serbia, Belgrade, Serbia

Institute of Hematology, Clinical Centre of Serbia, Belgrade, Serbia

Institute of Molecular Genetics and Genetic Engi­neering, Belgrade, Serbia