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Can a Missed Deep Vein Thrombosis Diagnosis Lead to Pulmonary Embolism?

September 28, 2020

A pulmonary embolism (PE) usually occurs when a blood clot known as a deep vein thrombosis (DVT) moves through the body to a person’s lungs and blocks a blood vessel. This creates low oxygen levels in the blood, and can result in damage to the lung and other organs. It can even cause heart failure.

A pulmonary embolism is serious and can be life-threatening. Thus, if you’ve been diagnosed with deep vein thrombosis, you should know about this risk. It’s critical that you advocate for the appropriate tests (discussed below) if you believe you have a DVT, and follow your treatment plan to stop the clot from becoming larger and also to keep new clots from forming.

What are the Common Symptoms of DVT ?

A deep vein thrombosis often starts in your leg, and while a pulmonary embolism doesn’t always cause symptoms, you might experience one or more of the following:

  • Chest pain that can worsen with a deep breath;
  • A sudden shortness of breath;
  • Rapid breathing;
  • A fast heartbeat;
  • A sudden cough;
  • Coughing up blood;
  • Lightheadedness;
  • Fainting; or
  • Anxiety.

What are the Complications?

If you have deep vein thrombosis, you may be at risk for damage to your veins and organs as well as other life-threatening issues. While not everyone with DVT will have problems, you may experience serious issues, such as pulmonary embolism (PE), chronic venous insufficiency, and post-thrombotic syndrome. Let’s look at each of these:

Pulmonary Embolism

DVT in the leg is the most frequent cause. A blood clot may break loose from a vein and move through the bloodstream to partially or completely block an artery in the lungs, which is known as a pulmonary embolism. A pulmonary embolism can happen immediately after the clot forms or later.

About 10% of those with deep vein thrombosis will have a pulmonary embolism. A pulmonary embolism can lead to serious problems, including:

  • An irregular heartbeat (heart palpitations);
  • Heart failure (the heart is unable to keep up with the body’s demands);
  • Difficulty breathing;
  • High blood pressure in the lungs, which is known as pulmonary hypertension; and
  • Sudden death in up to a quarter of those with a pulmonary embolism.

Post-Thrombotic Syndrome or Chronic Venous Insufficiency

This happens when a clot stays in your leg or arm for too long, damaging the vein or its valves. Valves that don’t work correctly allow blood to flow backwards and pool, rather than pushing it toward the heart.

Post-thrombotic syndrome is a long-term problem with pain, swelling, and redness. In addition, ulcers and sores can develop if it isn’t detected and treated right away. The complications and symptoms can make it difficult to walk and take part in other regular activities.

Roughly 50% of those with DVT will suffer long-term effects at the site of the clot. This can include:

  • Pain;
  • Skin sores;
  • Swelling;
  • Darkened skin color; and
  • Varicose veins (which are swollen, sometimes twisted or blue veins seen under the skin).

Blood that isn’t flowing efficiently is more likely to clot, causing a person to get another DVT or a pulmonary embolism.

Who’s More Likely To Get Blood Clots?

Some people are more apt to get blood clots, such as the following:

  • People with some medical issues, including cancers and inherited abnormalities of the blood-clotting system;
  • People on medications, such as birth control pills and hormone therapy;
  • Women who are pregnant;
  • Those who are very overweight; and
  • People with heart failure.

Anyone who develops DVT is at risk of developing a pulmonary embolism.

What is the Treatment?

Depending on a person’s symptoms, a drug called a thrombolytic may be prescribed to dissolve the clot. While this medication can save your life, it can also cause bleeding that’s difficult to stop. A patient taking a thrombolytic must be monitored closely in the hospital. In serious cases, a surgeon may need to break up and remove the clot.

When an individual’s symptoms aren’t serious, or if a thrombolytic would be too risky, the doctor may prescribe a medication that interrupts the clotting process or stops platelets in the blood from sticking together. Blood thinners are usually prescribed in this case. Anticoagulants such as heparin or warfarin (also known as Coumadin) slow down the body’s process of making clots. Antiplatelet drugs, like aspirin, prevent platelets from clumping together to form a clot.

If warfarin (Coumadin) is prescribed, the patient must have his or her blood frequently tested to make certain that they have the correct amount of the drug in their system.

But no blood testing is required if a newer blood thinner is prescribed, such as apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), or rivaroxaban (Xarelto).

What Tests Should Be Done To Rule Out DVT?

A doctor will examine a patients’ legs to see if there’s swelling and tenderness. The doctor may order a D-Dimer blood test or an ultrasound of the patient’s legs. This blood test measures the level of a chemical called D-Dimer, which is typically found to be extremely elevated when blood clots are actively forming in the body. An ultrasound is performed to check for blood flow issues in a patient’s veins. The procedure is called a lower extremity non-invasive test or “LENI.” If the test reveals evidence of a blood clot, the doctor will diagnose DVT.

If the initial LENI is negative, it doesn’t mean that there’s no clot because it can be too soon to determine the complete effect of the clot. The physician may ask the patient to come back in a few days for a second LENI. If a pulmonary embolism is suspected, the doctor will first try to determine if the patient has DVT. If the LENI shows one or more blood clots in the patient’s leg veins, and he or she is experiencing symptoms of a PE, an embolism is the most likely diagnosis.

In the alternative, a physician may order computed tomography (CT) of the patient’s chest. This test requires an IV injection of dye to look for blood clots in the pulmonary arteries.

Takeaway

Missed or delayed diagnosis of DVT can cause injury and even death. You should always be sure that your PCP follows up on areas of concern and refers you to a specialist when warranted.

If you or a loved one has suffered harm due to a missed or delayed deep vein thrombosis diagnosis, contact an experienced medical malpractice attorney at Buchanan Firm in Michigan for a free consultation. We can discuss your situation if you believe you’ve been injured as the result of a misdiagnosis, missed diagnosis, or an error in lab results.

Our firm proudly serves people all across Michigan, including major cities like Grand Rapids, Muskegon, Detroit, Lansing, Holland, St. Joe, and Ann Arbor, and rural towns such as Lowell, Ada, Fremont, Newaygo, Grand Haven, Rockford, and Cedar Springs. We will meet you after-hours, at home or in the hospital to accommodate you.

Contact us today!