PULMONARY THROMBO-EMBOLISM: DIFFICULTIES ENCOUNTERED IN ESTABLISHING CAUSAL RELATIONSHIP AND EXCLUDING THERAPEUTIC MISMANAGEMENT-A CASE REPORT

Pulmonary embolism designates blockage of pulmonary arteries by substancesmoved from elsewhere in the body through the circulation. The commonestform is thromboembolism. The presentation of pulmonary thromboembolism(PTE)isextremelyvariablefrombeingcompletelyasymptomatictosuddencar-diovascular collapse and death. Shortness of breath, chest pain and haemopty-sis areother common presentations. PTE is not a frequentlyencounteredentityin routine autopsy practice. Out of all cases detected at autopsy, approximatelyβifty percent are not clinically diagnosed or even suspected, making it one ofthe top pathological entities clinically underdiagnosed or misdiagnosed. Theautopsy, therefore remains the gold standard of post-mortem identiβication ofPTE. Autopsy also allows to establish or exclude a clinico-pathologic co-relationbetween the clinical diagnosis and actual cause established post-mortem. Legalissueswillariseastowhetheraparticulartraumaticeventhasacausalrelation-ship with the cause of death as PTE. Establishment of the cause of death (COD)as PTE, timing of the thrombotic event in relation to an ante-mortem traumaand exclusion of medical negligence on the basis of misdiagnosis and misseddiagnosis are some important medico-legal issues encountered by the foren-sic pathologist. The objective of this case presentation is to elaborate practicaldifβiculties encountered by the pathologist in addressing above medico-legalissues. The death of a 46-year-old male bike-rider from PTE, who died threedays after being discharged from the hospital on the 26thday following a trafβicaccident resulting in multiple rib fractures and severe abdominal trauma whichwarranted splenectomy is discussed here.