Missed Diagnosis of Blood Clot in Pregnant Patient Results in Fatal Pulmonary Embolism

This case involves a pregnant female who presented to the emergency room at thirty-five weeks complaining of shortness of breath, chest pain, and an increased heart rate. The patient was admitted, diagnosed with pneumonia, and sent to the ICU for close observation. No additional testing or cardiovascular imaging studies were performed and the patient was transferred to a medical step-down floor. The patient died soon after her transfer and the cause of death was determined to be a massive pulmonary embolism. The physicians on the patient’s case claim that they considered the PE as a possible differential diagnosis but no further tests were done to rule out this life-threatening condition.

Question(s) For Expert Witness

1. What is the standard of care in working up a patient that presents with these symptoms?

Expert Witness Response E-006017

Clinical signs and symptoms for pulmonary embolism are nonspecific. Therefore, patients suspected of having pulmonary embolism because of unexplained dyspnea, tachypnea, chest pain, or the presence of other risk factors for pulmonary embolism must undergo diagnostic tests until the diagnosis is ascertained, eliminated, or an alternative diagnosis is confirmed. Furthermore, routine laboratory findings are nonspecific and are not helpful in pulmonary embolism, although they may suggest another diagnosis. A hypercoagulation workup should be performed if no obvious cause for embolic disease is apparent. It is more likely that a pregnant woman may be in a state of hypercoagulation, and a pulmonary embolism should not be excluded until confirmatory tests suggest otherwise.