Autopsy evidence of pulmonary thromboembolism

Abstract

Objective: To determine the prevalence of pulmonary thromboembolism (PE) and underlying risk factors at autopsy, compared with clinical diagnosis.

Design: Retrospective review of autopsy records, death certificates and medical histories.

Patients and setting: All 132 patients who underwent autopsy at St Vincent's Hospital, Melbourne, in 1992.

Results: Sixteen cases (12% of autopsies) of PE were found at autopsy. In only two had PE been recorded on the death certificate; in one other, diagnosis had been made before death. Associated pulmonary infarction and/or haemorrhage was found in only six patients with PE. All 16 had at least one underlying risk factor: advanced age, cancer, heart disease, or recent pelvic or abdominal surgery. In four patients with missed PE, clinical records showed episodes consistent with PE. There were four false-positive diagnoses.

Conclusions: Significant undiagnosed pulmonary embolism is not uncommon at autopsy. Many episodes are clinically silent, but the diagnosis should be suspected in at-risk patients with unexplained episodes of dyspnoea and tachycardia.