88 results
35y · Female·Pulmonary thromboembolus and pulmonary infarction
A 35-year-old woman at 11 weeks gestation presented to Royal Women's Hospital Emergency Care on 3 September 2012 with chest and rib pain following severe vomiting. Dr M., a junior resident working alone overnight, assess…
14y · Male·ventricular arrhythmia on a background of congenital aortic valve disease
A 14-year-old boy with congenital aortic stenosis collapsed and died from ventricular arrhythmia during football training in March 2015. He had undergone aortic valve repair in 2006 and was under long-term cardiology fol…
67y · Male·respiratory failure with antecedent causes including chronic emphysematic lung d…
67-year-old male with 40-year smoking history presented with chest symptoms in 2012. CT scan revealed a left upper lobe mass. Core biopsy was incorrectly reported as adenocarcinoma by the pathologist, despite clinical un…
62y · Male·Multi-organ infarctions (brain, kidneys, heart) resulting from thromboemboli sec…
Mr TAM, a 62-year-old man with multiple cardiac conditions, died from multi-organ infarction secondary to an atrio-oesophageal fistula that developed after radio-frequency ablation for atrial fibrillation. The fistula is…
71y · Female·Haemothorax and haemopericardium secondary to ruptured dissecting aneurysm of th…
A 71-year-old woman with hypertension and prior myocardial infarction presented to emergency with sudden chest pain, jaw pain, and syncope. Aortic dissection was appropriately suspected and a contrast CT-aortagram was pe…
16y · Male·heart failure due to chronic rheumatic heart disease
A teenage boy with rheumatic heart disease died from heart failure at Princess Margaret Hospital. He had suffered rheumatic fever in 2006 and 2010, with mitral and aortic valve repair surgery in October 2010 that resulte…
58y · Female·Haemorrhagic shock complicating pulmonary thromboembolism in the setting of deep…
A 58-year-old woman with obesity (BMI 38) sustained a metatarsal fracture and was treated with a below-knee plaster cast by her GP. Despite appropriate initial assessment and consultation with a haematologist regarding V…
71y · Female·aortic dissection (Stanford Type A)
A 71-year-old woman presented to hospital with pericardial effusion causing cardiac tamponade, successfully treated by pericardiocentesis. The underlying cause was a Stanford Type A aortic dissection, which was not ident…
55y · Female·Cardiac tamponade due to haemopericardium due to acute ruptured myocardial infar…
A 55-year-old woman with extensive coronary artery disease presented for elective stent placement to her left anterior descending artery. During the procedure, a small diagonal branch vessel was occluded—a recognised com…
48y · Male·myocardial infarction due to coronary atherosclerosis (medically treated)
Garnett Mickelo, aged 48, died from myocardial infarction due to coronary atherosclerosis while in custody at Woodford Correctional Centre on 24 November 2012, shortly after discharge from Princess Alexandra Hospital fol…
62y · Male·Global cerebral ischaemia secondary to intra-operative hypotension following the…
A 62-year-old man died from global cerebral ischaemia following intra-operative hypotension after protamine administration during a cardiac ablation procedure. He had suffered a severe hypotensive reaction to protamine 8…
59y · Female·acute cardiogenic shock, with acute mechanical obstruction of a remote mechanica…
Ida Romeo, 59, died during cardiac catheterisation at Liverpool Hospital when a pressure wire became trapped in her mechanical aortic valve. She had consented to a right heart study to investigate suspected constrictive …
4y · Female·Haemorrhage due to aorto-oesophageal fistula caused by ingestion of a button bat…
A 4-year-old girl died from aorto-oesophageal fistula and haemorrhage caused by a lithium button battery lodged in her oesophagus for at least 3 days. Critical diagnostic failures occurred: the initial GP failed to consi…
77y · Male·Cerebral infarction (stroke) complicating elective hernia repair
A 77-year-old man with atrial fibrillation on warfarin underwent elective hernia repair. Warfarin was appropriately ceased five days pre-operatively. Post-operatively, warfarin was recommenced on day 1 post-op at 5pm. He…
22y · Female·ventricular fibrillation resulting from hypertrophic cardiomyopathy when her imp…
22-year-old woman with hypertrophic cardiomyopathy died from ventricular fibrillation when her implantable cardioverter defibrillator (ICD) failed to terminate the arrhythmia due to lead insulation failure caused by chro…
33y · Male·hypoxic respiratory failure following right pneumonectomy for treatment of sever…
Manjit Singh, a 33-year-old Indian 457 visa worker, died from hypoxic respiratory failure following a pneumonectomy for treatment of severe pulmonary tuberculosis. He had latent TB identified pre-arrival in India. Critic…
43y · Male·acute right heart failure (cor pulmonale) complicating foreign body (microcrysta…
A 43-year-old male died from acute right heart failure (cor pulmonale) caused by pulmonary granulomas resulting from intravenous injection of crushed methylphenidate (Ritalin) tablets. The microcrystalline cellulose bind…
71y · Female·cardiac tamponade due to ascending aortic dissection
A 71-year-old woman presented to the ED with sudden-onset epigastric pain requiring morphine. Despite clinical features concerning for acute aortic dissection (severe stabbing chest pain radiating to back, relieved by le…
40y · Male·haemopericardium complicating ascending thoracic aortic dissection
A 40-year-old man presented to the Northern Hospital ED with acute chest pain radiating to his throat, diaphoresis, and left hand tingling. Initial assessment by a junior doctor appropriately excluded cardiac ischaemia a…
20y · Male·stab injury to the back
A 20-year-old male died from exsanguination due to a stab wound to the back sustained during an organised group fight. The injury penetrated the lung and involved medium calibre pulmonary vessels. Despite immediate emerg…
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