A pulmonary embolism misdiagnosis claim arises when a blood clot that has traveled to the lungs, or a deep vein thrombosis (DVT) in the leg that is about to, goes unrecognized and untreated even though the patient’s symptoms and risk factors called for testing. In Virginia, it is a medical malpractice claim, and many of these cases also involve a failure to prevent the clot in the first place.
Blank Kim Injury Law reviews pulmonary embolism cases for patients and families across Northern Virginia from our Fairfax office. Many involve a recent operation, a hospital stay or a long trip, and a sudden collapse days later. Our team speaks English, Korean and Spanish.
Symptoms of a pulmonary embolism and DVT
Most pulmonary embolisms start as a clot in a deep vein of the leg or pelvis that breaks loose and lodges in the arteries of the lungs. Symptoms of a pulmonary embolism include:
- Sudden shortness of breath, at rest or with light activity
- Chest pain that is sharp and worse with a deep breath
- A fast heart rate or palpitations
- Coughing up blood
- Lightheadedness or fainting
- Low oxygen levels on a finger monitor
A DVT often comes first, with swelling, pain, warmth or redness in one calf or thigh. Those leg symptoms are sometimes the only warning, and they are easy to dismiss as a strain or cramp.
Risk factors that should raise suspicion
A careful provider asks about the conditions that make clots more likely. The more of them a patient has, the lower the threshold for testing:
- Surgery in the past several weeks, especially hip, knee, abdominal or cancer surgery
- A recent hospital stay or a period of bed rest
- A leg cast, brace or injury that limits walking
- Long flights or car trips, such as international travel through Dulles
- Estrogen-containing birth control or hormone therapy
- Active cancer or cancer treatment
- A previous clot, or a family history of clotting disorders
- Obesity, smoking and older age
How a pulmonary embolism should be ruled in or out
Emergency medicine uses a probability-based pathway, because testing everyone with shortness of breath is not practical and missing a clot can be fatal:
- Estimate the clinical probability with a validated tool such as the Wells score or the Geneva score.
- For low-probability patients, apply the PERC rule, which can end the workup if every criterion is met.
- For low or moderate probability, order a D-dimer blood test. A normal result makes a clot unlikely, and an elevated result calls for imaging.
- For high probability, go straight to imaging. A normal D-dimer should not be used to send a high-probability patient home.
- Image the lungs with CT pulmonary angiography, or a ventilation-perfusion scan when contrast dye is unsafe, and use ultrasound of the legs to look for a DVT.
- When suspicion is high and imaging will take time, consider starting a blood thinner while waiting, if bleeding risk allows.
Common errors include skipping the probability assessment, misapplying the D-dimer, and never imaging a patient whose risk factors and vital signs pointed toward a clot.
What pulmonary embolisms are mistaken for
Because its symptoms overlap with so many other conditions, a pulmonary embolism is often labeled as:
- A panic attack or anxiety, when fast breathing and a racing heart are the main complaints
- Pneumonia or bronchitis, especially when there is a cough or a low fever
- An asthma or COPD flare, in patients with a lung condition
- A muscle strain or pleurisy, when the chest pain is sharp and worse with breathing
- A negative heart workup, where a patient is cleared of a heart attack and sent home with no one considering a clot
- A calf strain or cramp, for the DVT that comes before the embolism
A persistently fast heart rate or low oxygen level that has no other explanation is a signal to keep looking. Our misdiagnosis page discusses how anchoring on a first impression leads to errors like these.
Clot prevention failures after surgery and hospital stays
Many hospital-acquired clots are preventable. Hospitals are expected to assess each admitted or surgical patient’s clot risk, using tools such as the Caprini or Padua scores, and to use prevention that fits that risk: blood thinners, compression devices on the legs and early walking.
Prevention claims arise when the risk assessment was never done, a blood thinner was ordered but doses were held or missed, compression devices were not applied, or a patient went home after joint replacement or major surgery without a plan for prevention at home. These cases overlap with surgical error claims and medication error claims.
What a missed clot can cause
- Sudden death, often days after the first symptoms were dismissed
- Strain and failure of the right side of the heart
- Cardiac arrest and resulting brain injury
- Chronic thromboembolic pulmonary hypertension, a lasting condition that limits breathing and activity
- Post-thrombotic syndrome, with long-term leg pain, swelling and skin damage after a DVT
When a pulmonary embolism is fatal, an autopsy is often the key evidence. If you have lost someone suddenly after a surgery, hospital stay or unexplained breathing trouble, ask about an autopsy as soon as possible, because the chance to perform one passes quickly.
Proving a missed pulmonary embolism in Virginia
We gather the vital signs, including heart rate and oxygen saturation over time, any risk assessment forms, D-dimer and imaging orders and results, the medication administration record for blood thinners, discharge instructions and, where there is one, the autopsy report. A physician in emergency, hospital or surgical medicine reviews the care, and a pulmonary or hematology physician explains what earlier diagnosis or prevention would likely have changed.
- Care is measured against a statewide standard under Va. Code § 8.01-581.20.
- A qualified expert witness’s written opinion must support the claim before suit is served, under Va. Code § 8.01-20.1.
- Suit generally must be filed within two years of the malpractice under Va. Code § 8.01-243(A). A wrongful death action generally must be filed within two years of the death under Va. Code § 8.01-244(B).
- Total damages are capped under Va. Code § 8.01-581.15.
For families, our malpractice wrongful death page explains who brings the claim and what it covers.
