An approach to the diagnostic management is very challenging in both populations, unfortunately. First, since they have been exclusively excluded from nearly all trials on the diagnosis of pulmonary embolism, neither clinical decision rules nor D-dimer testing has been validated in both populations. Second, symptoms of a VTE, such as tachycardia, tachypnea, and leg swelling, are often seen both in patients who are pregnant as a physiologic phenomenon and in patients on dialysis as a sign of fluid overload. Last, there is a physiologic increase of D-dimer in both populations,2,4 decreasing the specificity of this test. Given the paucity of data, what are the authors’ thoughts on the diagnosis of pulmonary embolism in patients who are pregnant and in patients with chronic renal failure?