Pulmonary Embolism: The Deadly Diagnosis ERs Miss Too Often

Pulmonary Embolism: The Deadly Diagnosis ERs Miss Too Often

By Hendrickson Law | Medical Malpractice Attorneys for Missouri Patients

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Key Takeaways

• Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States, after heart attack and stroke
• PE symptoms are notoriously nonspecific — shortness of breath, chest pain, and rapid heartbeat — and are routinely mistaken for less serious conditions
• Studies suggest more than one in four PE patients in emergency settings are initially misdiagnosed
• Untreated PE can be fatal; when an ER fails to consider or test for PE in a patient with known risk factors, that failure may be medical malpractice
• Time matters — if you or a loved one suffered serious harm after a PE was missed or delayed, contact a malpractice attorney as soon as possible

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When most people think about life-threatening emergencies, they think about heart attacks and strokes. But there is a third killer in that category — one that emergency rooms miss with alarming frequency, and one whose consequences can be just as devastating.

Pulmonary embolism. A blood clot that travels to the lungs and cuts off blood flow. Potentially fatal. Often preventable with prompt diagnosis and treatment. And missed in a significant portion of patients who present to emergency rooms with exactly the symptoms that should have triggered a workup.

Here is what patients and families need to know.

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What Is a Pulmonary Embolism?

A pulmonary embolism occurs when a blood clot — most commonly originating in the deep veins of the legs, a condition called deep vein thrombosis (DVT) — breaks free and travels through the bloodstream to the lungs. Once there, it blocks blood flow through the pulmonary arteries, depriving the body of oxygen and placing dangerous strain on the right side of the heart.

Small clots may cause limited damage and respond well to anticoagulant treatment. Larger clots — or multiple clots — can cause rapid cardiovascular collapse and death. Even patients who survive a significant PE without timely treatment can suffer lasting damage to the lungs and heart.

PE and DVT together are among the most common and most dangerous blood clot conditions in the United States. PE is the third most common cause of cardiovascular death, following heart attack and stroke.

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Why PE Gets Missed: The Symptom Problem

The core reason pulmonary embolism is so frequently missed in the emergency room is that its symptoms are nonspecific. They look like a lot of other things — some serious, some not — and busy ER providers under pressure to move patients through can anchor on a simpler explanation and stop looking.

Common PE symptoms include:

• Sudden shortness of breath — often the most prominent symptom, but easily attributed to anxiety, asthma, or other respiratory conditions
• Chest pain — frequently sharp and worsened by breathing, but often mistaken for musculoskeletal pain, pleurisy, or even a panic attack
• Rapid heart rate — a sign the heart is working harder to compensate for reduced oxygen flow
• Cough — sometimes with blood-tinged sputum, but often dry and unremarkable
• Lightheadedness or fainting — which can point in many directions
• Leg pain or swelling — a potential sign of the underlying DVT, but not always present or recognized as significant

What makes PE particularly dangerous is that many patients present with only one or two of these symptoms, and sometimes in combinations that suggest something far more benign. A young woman with shortness of breath and chest pain may be told she is having a panic attack. An older patient with leg swelling and fatigue may be sent home with a diagnosis of muscle strain. A post-surgical patient with rapid heartbeat may have it attributed to pain medication or dehydration.

Meanwhile, the clot remains.

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Who Is at Risk — and Why Risk Factors Matter Legally

Certain patients are at significantly elevated risk for PE, and an emergency physician's failure to recognize and act on those risk factors is often at the center of a malpractice claim. Known risk factors include:

• Recent surgery — particularly orthopedic procedures like hip and knee replacements, which carry high clot risk
• Extended immobility — long flights, hospital bed rest, or post-operative recovery
• Cancer — malignancy dramatically increases clotting risk
• Prior history of DVT or PE
• Pregnancy or recent childbirth
• Use of oral contraceptives or hormone therapy
• Obesity
• Older age

When a patient with one or more of these risk factors presents with shortness of breath and chest pain, a competent emergency physician is expected to include PE in the differential diagnosis and take appropriate steps to evaluate for it. Those steps have been well established in emergency medicine for years: D-dimer blood testing, clinical risk-scoring tools like the Wells Criteria, and CT pulmonary angiography (CTPA) — the imaging study that can definitively identify a clot in the pulmonary arteries.

Failing to order the right tests in a patient with a concerning presentation and known risk factors is not a judgment call that falls within the range of acceptable medical practice. It is a failure to meet the standard of care.

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How the Missed Diagnosis Causes Harm

Studies suggest that more than one in four PE patients in emergency settings are initially misdiagnosed. The harm from that missed diagnosis can unfold in several ways:

The patient is sent home and deteriorates. A patient discharged without anticoagulation therapy can suffer clot progression, right heart failure, or sudden death in the hours or days following discharge.

The clot causes permanent lung damage. Even in patients who survive, an untreated or significantly delayed PE can cause chronic thromboembolic pulmonary hypertension — a serious, lifelong condition that impairs breathing and limits physical capacity.

The delay allows additional clots to form. Without anticoagulation, new clots can develop and compound the damage from the original embolism.

Death. Untreated PE carries mortality rates that, in serious cases, can reach as high as 30%. Many of these deaths occur in patients who were discharged from an emergency room with a missed or incorrect diagnosis.

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What a Malpractice Case Looks Like

Not every missed PE is malpractice. Some presentations are genuinely subtle, and some patients have no known risk factors and atypical findings. But when the evidence shows that a patient presented with clear warning signs, had identifiable risk factors, and was sent home without appropriate evaluation — and then suffered serious harm as a result — the elements of a malpractice claim are often present.

A viable case generally requires establishing:

• The provider breached the standard of care by failing to consider PE in the differential diagnosis, failing to order appropriate testing, or failing to recognize abnormal test results
• That failure caused the patient's harm — meaning the delay in diagnosis made the outcome meaningfully worse than it would have been with timely treatment
• The harm was serious and lasting

These cases require expert physician testimony and a careful review of the emergency room records — what the patient reported, what the provider documented, what tests were ordered or not ordered, and what the discharge diagnosis and instructions said.

For more on how the standard of care works in emergency medicine cases, see Why "Just a Mistake" Can Still Be Malpractice: Understanding Legal Standards. For a broader look at how ER misdiagnoses happen, see When the ER Gets It Wrong: Common Emergency Room Misdiagnoses.

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What to Do If You Suspect a Missed PE

If you or a loved one suffered serious harm — or lost someone — after a pulmonary embolism was missed or significantly delayed, here are the steps to take:

1. Request all emergency room records immediately — including triage notes, nursing records, physician documentation, lab results, and imaging
2. Write down everything you remember — symptoms reported, what the doctor said, when the patient was discharged, and what happened next
3. Contact a malpractice attorney as soon as possible — Missouri's statute of limitations is unforgiving, and the earlier a case is evaluated, the better

At Hendrickson Law, Todd Hendrickson personally evaluates every case. We know what emergency physicians are expected to do when a patient presents with PE risk factors — and we know what the records should show if they did their job. We will give you a straight answer about whether the care your family received fell short of what the law requires.

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📞 Was a Pulmonary Embolism Missed in Your Case?

Call Hendrickson Law today at (314) 721-8833 or visit www.hendricksonlaw.com for a free, confidential consultation.

A missed PE is not bad luck. When the warning signs were there and the evaluation was not, it may be malpractice — and you deserve to know the difference.