Medicolegal analysis of lethal pulmonary thromboembolism in hospitalized patients: an autopsy-based study

Pulmonary thromboembolism (PTE) is lethal and is frequently associated with medical disputes. Me main objectives of this study were to clarify the medicolegal characteristics of lethal PTE. The authors investigated 30 autopsy cases of PTE and reviewed postmortem findings and medical records. During autopsy, 28 of 30 patients (93.3%) had thrombi in the pulmonary trunk or main pulmonary arteries, and deep vein thrombosis of the leg was verified in 23 patients (76.7%). Death certificates were submitted in 27 cases and the cause of death was assumed to be PTE in 10 cases (37.0%). Among 30 patients, 22 underwent surgery and various risk factors such as immobilization, obesity, and old age were noted. The average duration from immobilization to death was 4.7 days. The duration from admission to the occurrence of PTE symptoms was approximately 7.3 days and duration from occurrence of PTE symptoms to death was approximately 1.9 days. The most common symptoms were dyspnea (17 patients), chest discomfort (11 patients), and syncope (6 patients). Chest computed tomography was performed in 8 patients but PTE findings were observed only 3 patients. D-dimers were evaluated in 6 patients and were elevated in all patients. An appropriate observation and prophylaxis is essential in patients with risk factors for PTE and role of forensic pathologist is important to perform an autopsy and review medical records for medical dispute about PTE.