Pulmonary Embolism Misdiagnosis
May I thank you for the way my accident claim has been handled, after my accident my confidence was very low indeed but the sympathetic handling of my case restored my confidence.
John, Sheffield
A pulmonary embolism ("PE") is a sudden blockage in a lung artery. This is usually as a result of a blood clot travelling to the lung from the leg, although the clot can travel from other parts of the body. The clot itself is called an embolus.
PE is a very serious condition. It can cause damage to the lung because of lack of blood flow to the lung; reduced oxygen levels in the blood and damage to other organs because of the reduced oxygen levels. Death can be caused by a very large clot (embolus) or sometimes a number of small clots.
Who is at risk?
According to research people at risk include:
This is not an exhaustive list
- Those who are inactive for long periods of time (which is a reason why there is now guidance for passengers on long-haul flights to keep active and perform exercises during flights)
- Patients who have had some form of surgery (especially obstetric/gynaecological, abdominal, knee or hip surgery
- People who are overweight
- Women that are pregnant or who have just given birth
- People that have had a heart attack or a stroke
- People with a cardiovascular disease
- Those who have fractured a hip or femur
- Patients who suffer from cancer or chronic lung disease
- Women who use birth control pill
Symptoms
The symptoms vary but can include the following:
This is not an exhaustive list
- Shortness of breath
- Chest pain
- Lightheadedness/fainting
- Wheezing
- Clammy/blue skin
- Weak pulse
- Leg swelling
- Anxiety
Diagnosis
Diagnosing PE early enough to treat it is very important. Some research available suggests that 10% of patients die if the PE is not treated.
If the symptoms are picked up on early enough then the patient can be treated, usually by being given intravenous heparin (a drug which thins the blood) and thus allows the clot to dissolve and for blood to flow more freely around the body.
PE Misdiagnosis
Unfortunately there are times when a PE diagnosis can be delayed or when PE can be misdiagnosed completely. We have represented clients in cases where GPs following an examination of patients have failed to refer them to hospital for immediate examination and also where patients attend hospitals with many of the symptoms indicative of PE but appropriate action has not been taken by a treating doctor/consultant. There are also situations where patients, following surgery, have not been given correct advice regarding the risk of PE. In PE cases even a small delay in diagnosis and treatment can have fatal consequences.
Case Study - Sarah's story
Sarah (aged 29) had undergone an emergency caesarean section to deliver her baby due to a diagnosis of pre-eclampsia during the later stages of her pregnancy. Around two weeks after being discharged from the hospital, she started to experience shortness of breath on a number of occasions and attended the maternity department of the hospital where she had delivered her baby advising them of the breathlessness and chest pain. The doctor also noted a wheeze. Asthma was diagnosed. PE was eventually diagnosed but only 2 days after Sarah was admitted to hospital. PE was not considered as a possible diagnosis on the day of admission. Sadly, Sarah suffered a cardiac arrest three days after she was admitted to hospital and died. By the time that PE was diagnosed it was too late to save her.
Had the PE been diagnosed on the day Sarah was admitted to hospital, it is more likely than not that treatment by intravenous heparin would have saved her life.
A case was pursued against the Trust for negligently failing to diagnose PE. The case was successful and compensation was awarded to Sarah's husband and daughter.
Comment on Sarah's story
It is very important that PE is diagnosed early. Sarah showed symptoms of PE and was at risk of PE because she had undergone obstetric surgery (the caesarean section). She had shortness of breath and chest pain. The doctors who saw Sarah did not appreciate the risk factor and symptoms. PE should have been ruled out before considering asthma but instead it was not considered until much later on and, by then, it was too late.