Pulmonary Embolisms Misdiagnosis Malpractice

What Are Blood Clots (DVT) and Pulmonary Embolisms (PE)?

Pulmonary Embolism (PE) affects about 500,000 people in the United States annually and is most often caused by a blood clot starting in the leg, Deep Vein Thrombosis (DVT), that ultimately breaks off, travels through the right heart into the lung, and blocks blood flow to the lung and oxygen to the body. Once a DVT forms, it will generally increase in size until a portion breaks off, travels toward the heart and becomes a PE when it passes through the pulmonary artery and gets trapped in the lungs. Symptoms of PE can range from sudden death to heart attack to mild discomfort, depending on the number of clots, the location of their embolization and their size(s). Untreated pulmonary embolisms have up to a 30% mortality rate and, even with treatment, pulmonary embolisms can have up to an 8 % mortality rate. The most dangerous PE is known as a “saddle embolism; this occurs when a large clot blocks the bifurcation of the main pulmonary artery and immediately shuts down blood flow to both lungs and can cause sudden death. The failure to diagnose high risk conditions and to promptly evaluate potential signs of DVT/PE can lead to pulmonary embolism misdiagnosis with serious consequences, including wrongful death.

Who Is at Increased Risk for Blood Clots and Pulmonary Embolisms?

Risk factors for developing a pulmonary embolism are the same risk factors for developing DVT in the legs and pelvic veins. Prolonged immobility such as during post-operative bed rest and long airplane flights are common causes of increased risk for DVT. Cancer, smoking, pregnancy, and obesity also increase the risk of DVT. Genetic conditions such as Factor V Leiden mutation is a hereditary condition that causes increased clotting in the vascular system. More recently, Covid infection and possibly the Covid vaccine can cause DVT in various locations because of inflammation of the blood vessel lining, the endothelium, which leads to clots. Although more common in people over 60 years of age, it can occur at any age.

How Is PE Prevented and Treated?

Physicians can only prevent unnecessary death and disability from DVT/PE by identifying high-risk patients and promptly evaluating symptoms. Prevention of DVT/PE in high-risk patients like postoperative orthopedic patients and patients with prolonged immobility is done with anticoagulants. These medications prevent new clots from forming and old clots from growing, and include heparin, direct oral anticoagulants (e.g. Eliquis, Xarelto and Pradaxa) and Coumadin for long term use in some patients. Although not first line, aspirin also has anti-platelet action and can be used in some lower-risk patients. Once a patient has a PE, additional treatment for the heart and complications of lung infarction are often required.

What Are Symptoms of DVT and PE?

DVT often causes complaints of leg cramps or leg swelling which merit evaluation and physical examination. Signs include unilateral leg swelling, pain or tenderness in the calf, warmth, redness or discoloration, a palpable cord-like structure in the leg, and pitting edema in the foot. However, not all patients exhibit signs, and some people have no symptoms. Combining the patient’s history with physical signs allows for a risk assessment to determine the likelihood of DVT and the need for further testing. If DVT is suspected, the next step is an ultrasound of the lower-extremity venous system to see if a clot is present.

Prompt recognition of DVT is important to prevent progression to a PE or other long-term complications. PE often causes collapse, chest pain, difficulty breathing, rapid heart rate, cough, and often lightheadedness and sweating. While some cases of PE are dramatic, some cases are subtle with only fatigue, mild breathlessness, and anxiety as main complaints. Symptoms such as these require work-up and evaluation with a full cardiovascular examination and CT Chest scan to rule our emboli. Laboratory testing includes D-Dimer testing, which measures the presence of clot breakdown, arterial blood gas testing (ABG) to check the oxygenation within the lungs, coagulation studies (PT, PTT and INR), troponin and BHP. Positive tests confirm the need for imaging,  Physicians, physician assistants and nurse practitioners need to maintain a heightened awareness and proactively look for DVT/PE signs to promptly diagnose and start anticoagulation and supportive treatment.

Contacting an Experienced DVT Pulmonary Embolism Attorney

When patients and family members have concerns about whether death or serious injury was caused by medical malpractice, it is important to talk to attorneys familiar with handling pulmonary embolism injuries like Britcher, Leone & Sergio, LLC. It is important to find out whether there were signs of DVT or PE that were overlooked or not protected against, things an experienced PE attorney knows to look for. Knowing the high-risk situations and signs that need to be identified makes a difference in finding out the injuries caused by medical negligence from those that were not. Contact us for an experienced DVT pulmonary embolism attorney.