Inquest into the Death of Dylan James RILEY

16y · Male·pulmonary embolism secondary to nephrotic syndrome

Dylan Riley, a 16-year-old with steroid-responsive minimal change nephrotic syndrome, died from a massive pulmonary embolism (PE) on 1 August 2015. He presented to Rockingham Hospital with dyspnoea, hypoxia, tachycardia and hypotension during a disease relapse. Doctors appropriately diagnosed acute pulmonary oedema—a common complication of nephrotic syndrome—and transferred him to Fiona Stanley Hospital's ICU. Although PE was considered and prophylactic anticoagulation (Clexane) was given, no specific investigations for PE were performed initially. When symptoms persisted, an echocardiogram revealed massive PE with right heart failure. Thrombolysis was attempted but failed. Expert opinion confirmed that PE is extremely rare in paediatric steroid-responsive nephrotic syndrome; the medical approach focusing on the more common diagnosis of pulmonary oedema was reasonable. Earlier PE diagnosis would have offered the best chance of survival, but experts could not definitively state it would have altered the outcome. No medical errors or failures were identified; the case represents a tragic, rare, and difficult-to-predict complication.