Fatal pulmonary embolization after negative serial ultrasounds

Area of Science:

• Emergency Medicine
• Vascular Surgery
• Diagnostic Imaging

Background:

• Isolated distal deep vein thrombosis (DVT) is often underestimated as a non-life-threatening condition.
• Clinical practice and recommendations for evaluating and treating distal DVT show significant variability.
• The potential for severe outcomes associated with distal DVT necessitates further investigation.

Observation:

• A previously healthy young woman presented with calf pain suggestive of DVT.
• Two serial radiologist-performed duplex ultrasound examinations of the affected extremity yielded negative results for DVT.
• The patient experienced sudden cardiac arrest several hours after the second negative ultrasound examination.

Findings:

• Autopsy confirmed the cause of death as deep vein thrombosis (DVT) and subsequent pulmonary embolism.
• This case demonstrates a fatal outcome from DVT despite negative serial ultrasound findings.
• The autopsy findings highlight the risk of pulmonary embolism even when initial diagnostic imaging is unremarkable.

Implications:

• Emergency physicians must remain aware of the potentially fatal risk of pulmonary embolism from distal DVT.
• Normal serial ultrasound examinations do not entirely exclude the possibility of life-threatening DVT.
• This case emphasizes the importance of considering clinical suspicion alongside diagnostic imaging in DVT evaluation.