Liability for Undiagnosed Pulmonary Embolism

Pulmonary embolism is a potentially fatal condition caused by a blood clot - and it's not always diagnosed properly. In some cases, a medical negligence claim can be brought.

A pulmonary embolism (PE) is the blockage of the pulmonary artery (a major artery in the lung), usually caused by a blood clot. The severity of PE depends primarily on two factors: the size of the blockage and the speed of diagnosis and treatment.

A small PE can cause no symptoms and can have no significant effect on the patient’s health. A large PE can cut off blood flow to the lungs and can even be fatal.

Pulmonary Embolism is one of the most commonly misdiagnosed medical problems. Misdiagnosis of PE is a major problem because the damage caused by PE increases with time. Thus, a doctor’s failure to properly diagnose PE can lead to catastrophic harm to a patient. (In some cases, the pulmonary embolism is itself the outcome of negligent medical treatment.)

This article discusses the procedure for diagnosing PE, why doctors sometimes have difficulty properly diagnosing PE, and how a medical malpractice case for failure to properly diagnose PE might proceed.

Proper Diagnosis Procedure for PE

The most common symptoms of PE include the following:

  • shortness of breath
  • sharp chest pain when inhaling
  • cough
  • calf or thigh pain, and
  • calf or thigh swelling.

But the symptoms of PE are generally considered by doctors to be insufficient by themselves to diagnose PE. This is because multiple other maladies have similar symptoms, including heart attack and anxiety attack. In fact, 32% of patients with Deep Vein Thrombosis (which is the most common cause of PE) are asymptomatic.

When a patient comes to a doctor and appears to be suffering from some of the above symptoms, the doctor will likely first determine the likelihood that the patient is suffering from PE. That determination is based on the symptoms as well as other factors including whether a patient has recently had surgery, the age of the patient, and whether the patient is obese.

The doctor will then usually perform diagnostic tests on the patient in order to determine whether the patient is suffering from PE. Doctors use a variety of tests for this purpose, including,

  • D-dimer
  • CT-PA
  • V/Q scan
  • pulmonary angiogram, and
  • lower extremity venous ultrasound.

The results of one or more of these tests, considered in light of the patient’s symptoms and medical history, should be sufficient for a doctor to conclusively determine whether a patient is suffering from PE.

Misdiagnosis

Since the symptoms of PE are similar to the symptoms of other conditions, misdiagnosis is easy. A few of the conditions that are most commonly confused with PE are identified below.

Heart Attack

Symptoms of a heart attack include chest pain, sweating, shortness of breath, nausea, and vomiting. Radiographic imaging generally helps doctors distinguish between a heart attack and PE.

Pneumonia

Pneumonia is a fairly common condition caused by an infection that results in inflammation of the lungs. Some of the most common symptoms associated with pneumonia include cough, fever, and fast, heavy breathing. Doctors generally use radiographic imaging to distinguish pneumonia from PE - which opens up another potential avenue for negligence, if the results are misread or misinterpreted.

Lung cancer

Lung cancer can also involve symptoms similar to PE. But lung cancer symptoms tend to develop more slowly, as the tumor develops. Thus, doctors can usually develop a qualified guess as to which malady is involved based on the patient’s medical history. But diagnostic imaging is usually used to confirm the diagnosis.

Proving That The Diagnosis Error Amounts to Malpractice

In assessing most patients who present with a potential health problem, a doctor performs what’s called a differential diagnosis. This means making a list of possible medical conditions that could be behind the symptoms, conducting a series of tests, then ruling out different conditions that don’t match up to test results until a definitive diagnosis can be determined. So, let’s take the case of a patient who presents with potential symptoms of PE, but the doctor fails to properly diagnose the condition, and sends the patient home, saying it’s just pneumonia.

In order to hold the doctor legally liable for medical malpractice, the patient (usually through his or her attorney and a retained medical expert witness) will show how the doctor deviated from the accepted medical standard of care in conducting the differential diagnosis -- first walking the jury through what a reasonably skilled physician would have done under similar circumstances, and then showing how the doctor’s chosen course of treatment in the instant case failed to meet that standard.

These are difficult cases to win under the best of circumstances, so the best first step is usually to find an attorney with experience handling similar cases - and ready access to medical experts.

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