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Misdiagnosis of Deep Vein Thrombosis (DVT) and Pulmonary Embolism

Excerpt: DVT and pulmonary embolism are life-threatening conditions that are frequently misdiagnosed as less serious problems. When the diagnosis is missed, the result can be sudden death from PE.

The Silent Killer: DVT and Pulmonary Embolism

Deep Vein Thrombosis (DVT) is a blood clot that forms in the deep veins, usually in the legs. Pulmonary Embolism (PE) occurs when a piece of the clot breaks off and travels to the lungs, potentially causing sudden death.

Together, DVT and PE affect an estimated 900,000 Americans each year and kill approximately 100,000 — more than breast cancer, HIV, and motor vehicle accidents combined. Yet these conditions are frequently misdiagnosed as less serious problems, with devastating consequences.

The misdiagnosis of DVT and PE is a common and often fatal medical error. When emergency room physicians, primary care doctors, or hospitalists fail to recognize the signs and order the appropriate tests, the patient may suffer a fatal pulmonary embolism — a death that could have been prevented with prompt diagnosis and anticoagulation.

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Risk Factors for DVT and PE

Physicians should be particularly vigilant for DVT/PE in patients with:

• Recent surgery — Especially orthopedic surgery (hip, knee)
• Immobility — Hospitalization, bed rest, long flights
• Cancer — Active malignancy increases clot risk
• Pregnancy and postpartum
• Oral contraceptives or hormone replacement
• History of DVT/PE
• Inherited clotting disorders — Factor V Leiden, protein C/S deficiency, antithrombin deficiency
• Obesity
• Smoking
• Advanced age
• Central venous catheters

However, DVT and PE can occur in any patient — including young, healthy individuals. The physician must maintain a high index of suspicion.

Signs and Symptoms of DVT

Symptoms of Deep Vein Thrombosis

• Unilateral leg swelling — One leg is larger than the other
• Leg pain or tenderness — Often in the calf
• Warmth — The affected leg is warm to the touch
• Redness or discoloration
• Surface veins — Become more visible

Symptoms of Pulmonary Embolism

• Sudden shortness of breath — The most common symptom
• Chest pain — That worsens with deep breathing (pleuritic)
• Cough — May be bloody (hemoptysis)
• Rapid heart rate (tachycardia)
• Anxiety or sense of doom
• Syncope (fainting)
• Sudden death

How DVT and PE Are Misdiagnosed

1. DVT Misdiagnosed as Other Conditions

DVT is frequently misdiagnosed as:

• Cellulitis — A skin infection
• Muscle strain — Especially calf pain attributed to "pulled muscle"
• Baker's cyst — A fluid-filled cyst behind the knee
• Peripheral edema — "Swelling" attributed to heart failure or venous insufficiency
• Superficial thrombophlebitis — A less serious clot in a surface vein

2. PE Misdiagnosed as Other Conditions

PE is frequently misdiagnosed as:

• Pneumonia — Chest pain, cough, and shortness of breath
• Asthma exacerbation — Shortness of breath and chest tightness
• Anxiety or panic attack — Shortness of breath and chest pain
• Musculoskeletal chest pain — Pleuritic pain attributed to "muscle strain"
• Heart attack — Chest pain and shortness of breath
• Bronchitis — Cough and shortness of breath

3. Failure to Use Diagnostic Algorithms

The standard of care for evaluating suspected DVT/PE includes validated diagnostic algorithms:

• Wells Score — A clinical prediction rule that stratifies patients by risk
• D-dimer — A blood test that, when negative in low-risk patients, can rule out DVT/PE
• Compression ultrasound — For suspected DVT
• CT pulmonary angiography (CTPA) — For suspected PE

Failure to use these algorithms — or failure to interpret the results correctly — may be negligence.

4. Failure to Order D-dimer

The D-dimer is a blood test that measures a breakdown product of blood clots. In low-risk patients, a negative D-dimer effectively rules out DVT/PE. Failure to order a D-dimer in a low-risk patient with suspected DVT/PE — or failure to order imaging in a patient with a positive D-dimer — may be negligence.

5. Failure to Order Imaging

• Compression ultrasound — The standard for diagnosing DVT. Failure to order ultrasound for suspected DVT may be negligence.
• CT pulmonary angiography (CTPA) — The standard for diagnosing PE. Failure to order CTPA for suspected PE may be negligence.

6. Failure to Anticoagulate

When DVT or PE is diagnosed (or strongly suspected pending confirmation), the standard of care requires anticoagulation (blood thinners) — unless contraindicated. Failure to start anticoagulation may allow the clot to grow or embolize.

Consequences of Delayed Diagnosis

• Pulmonary embolism — The clot travels to the lungs
• Sudden death — From massive PE
• Pulmonary hypertension — Chronic PE causing elevated lung pressures
• Post-thrombotic syndrome — Chronic leg swelling and pain after DVT
• Larger clot — The clot grows while undiagnosed and untreated
• Stroke — In patients with a patent foramen ovale (PFO), a venous clot can cross to the arterial system

Proving a DVT/PE Misdiagnosis Claim

Key Evidence

• Emergency room or hospital records — Documenting the patient's presentation and evaluation
• Wells Score and D-dimer results — Whether risk stratification was performed
• Imaging results — Ultrasound, CTPA, or V/Q scan
• Anticoagulation records — Whether and when blood thinners were started
• Expert testimony — From an emergency medicine physician, hematologist, or pulmonologist

Expert Witnesses

DVT/PE cases require testimony from:

• An emergency medicine physician — On the standard of care for evaluating suspected DVT/PE
• A hematologist — On clotting disorders and anticoagulation
• A pulmonologist or cardiologist — On PE management
• A vascular surgeon — In cases requiring surgical intervention

Statute of Limitations

Under CPLR 214-a, the statute of limitations is 2.5 years from the date of the malpractice.

Frequently Asked Questions

Can I sue for failure to diagnose DVT or PE?

Yes. If the physician failed to recognize the signs, failed to order appropriate tests (D-dimer, ultrasound, CTPA), or failed to start anticoagulation, and this caused additional injury or death, you may have a malpractice claim.

What is a D-dimer test?

A D-dimer is a blood test that measures a breakdown product of blood clots. In low-risk patients, a negative D-dimer can effectively rule out DVT/PE. A positive D-dimer requires further imaging.

What is the Wells Score?

The Wells Score is a clinical prediction rule that stratifies patients by their risk of DVT or PE based on clinical findings. It guides the diagnostic workup — low-risk patients may be evaluated with D-dimer alone, while high-risk patients require imaging.

Can a pulmonary embolism be misdiagnosed as a panic attack?

Yes. PE is frequently misdiagnosed as anxiety or panic attack because both cause shortness of breath, chest pain, and a sense of doom. The standard of care requires ruling out PE before attributing symptoms to anxiety.

How long do I have to file a claim?

Under CPLR 214-a, the deadline is generally 2.5 years from the date of the malpractice.

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If you or a loved one has been affected by misdiagnosis of DVT or pulmonary embolism in New York, contact MDLaw Firm at 347-524-5777 for a free consultation.

This article is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome. No attorney-client relationship is created by reading this article or contacting MDLaw Firm.