Lack of appreciation for significant elements of the patient’s history and physical led to a missed PE

Diagnostic Assessment: Case Example

A 33-year-old obese patient with remote history of asthma, and on oral contraceptives, presented to her primary care clinician with a three-day complaint of right thigh pain, swelling, and red streaking on her skin. On exam, her right inguinal lymph nodes were enlarged and antibiotics were prescribed.

Three days later, she returned with complaint of new onset shortness of breath, chest pain, and rapid heart rate. The patient had diminished breath sounds. Her physician thought she was having an asthma flare and advised her to continue antibiotics and asthma medications.

Later the same day, emergency personnel were called to the patient’s home after she fell. She was brought to a local Emergency Department where she quickly decompensated and died. Autopsy revealed a large pulmonary thromboembolism.

(Case settled: $450K)

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