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Coroner's Finding: Paraskevas, Odissefs

Deceased

Odissefs Paraskevas

Demographics

56y, male

Date of death

2017-01-30

Finding date

2019-03-08

Cause of death

pulmonary thromboembolism due to left deep vein thrombosis

AI-generated summary

A 56-year-old man died from pulmonary thromboembolism secondary to deep vein thrombosis. He presented to his GP on 20 January 2017 with persistent dyspnoea and chest pain following a 22-hour flight to Greece and respiratory infection there. The GP diagnosed heart failure exacerbated by chronic lung disease and obesity but did not consider PE as a differential diagnosis. No D-dimer was ordered. The coroner found that application of standardised PE evaluation criteria (Wells score and PERC) would have mandated D-dimer testing given the patient's age >50 and heart rate >100 bpm. A positive D-dimer would likely have led to urgent CTPA, detection of PE, and anticoagulation therapy, offering the best prospect of survival. The case highlights the diagnostic challenge of PE and the value of systematic risk stratification tools in general practice.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.

Specialties

general practicecardiologyvascular surgerypathology

Error types

diagnosticdelay

Clinical conditions

pulmonary embolismdeep vein thrombosisheart failurechronic lung diseaseobesityhypertensionrespiratory infection

Procedures

chest x-rayblood testsD-dimer

Contributing factors

  • long-haul air travel
  • recent respiratory infection
  • obesity
  • hypertension
  • elevated cholesterol
  • enlarged heart
  • failure to apply PE risk stratification criteria
  • failure to order D-dimer testing
  • absence of classical DVT signs on examination

Coroner's recommendations

  1. Medical practitioners, particularly those in general practice, should familiarise themselves with and apply the guide for evaluation of suspected PE set out in the 2018 RACP research paper 'Update on Diagnosis and Anticoagulant Therapy for Venous Thromboembolism' published in the Internal Medicine Journal
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