Abstract
Pulmonary embolism designates blockage of pulmonary arteries by substances moved from elsewhere in the body through the circulation. The commonest form is thromboembolism. The presentation of pulmonary thromboembolism (PTE) is extremely variable from being completely asymptomatic to sudden cardiovascular collapse and death. Shortness of breath, chest pain and haemoptysis are other common presentations. PTE is not a frequently encountered entity in routine autopsy practice. Out of all cases detected at autopsy, approximately fifty percent are not clinically diagnosed or even suspected, making it one of the top pathological entities clinically underdiagnosed or misdiagnosed. The autopsy, therefore remains the gold standard of post-mortem identification of PTE. Autopsy also allows to establish or exclude a clinico-pathologic co-relation between the clinical diagnosis and actual cause established post-mortem. Legal issues will arise as to whether a particular traumatic event has a causal relationship 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 trauma and exclusion of medical negligence on the basis of misdiagnosis and missed diagnosis are some important medico-legal issues encountered by the forensic pathologist. The objective of this case presentation is to elaborate practical difficulties encountered by the pathologist in addressing above medico-legal issues. The death of a 46-year-old male bike-rider from PTE, who died three days after being discharged from the hospital on the 26th day following a traffic accident resulting in multiple rib fractures and severe abdominal trauma which warranted splenectomy is discussed here.
Highlights
Embolism means obstruction of a blood vessel by a foreign substance or a blood clot which travels through the circulation
When embolism occurs due to a dislodged blood clot, it is termed thrombo-embolism which is by far the commonest form of embolism
Most cases of pulmonary thromboembolism (PTE) are resultant to deep venous thrombosis (DVT) of lower limbs and less commonly of other sites such as pelvic veins
Summary
Embolism means obstruction of a blood vessel by a foreign substance or a blood clot which travels through the circulation. Kumar and Kaca (2018); Saukko and Kb (2015) When a person succumbs to PTE following a signi icant traumatic event with or without surgery, the question arises as to the level of contribution of the trauma (which could be an accident, suicidal event or a homicidal attempt) to result in pulmonary thrombo-embolism Another issue the forensic pathologist conducting the autopsy will have to address is the contribution of surgery towards PTE. If special dissections are not employed with or without special investigations and due caution is not exercised during the autopsy, certain marginal cases of PTE may be missed even at the post-mortem examination. von Both et al (2018)
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