Coroner's Finding: Paraskevas, Odissefs

56y · Male·pulmonary thromboembolism due to left deep vein thrombosis

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.