• Sanjaya Hulathduwa Senior Lecturer, Department of Forensic Medicine, Faculty of Medical Sciences, University of Sri Jayawerdenepure, Sri Lanka https://orcid.org/0000-0002-4583-2703
  • Bandula Wijesinghe Senior Registrar in Forensic Medicine, Colombo South Teaching Hospital, Kalubowila, Sri Lanka




Pulmonary Thromboembolism, Deep Vein Thrombosis, Trauma, Traffic Accidents, Special Stains


Pulmonary embolism designates blockage of pulmonary arteries by substances moved from elsewhere in the body through the circulation. The commonest form is thromboembolism. The presentation of pulmonary thromboembolism (PTE) is extremely variable from being completely asymptomatic to sudden cardiovascular collapse and death. Shortness of breath, chest pain and haemoptysis are other common presentations. PTE is not a frequently encountered entity in routine autopsy practice. Out of all cases detected at autopsy, approximately fifty percent are not clinically diagnosed or even suspected, making it one of the top pathological entities clinically underdiagnosed or misdiagnosed. The autopsy, therefore remains the gold standard of post-mortem identification of PTE. Autopsy also allows to establish or exclude a clinico-pathologic co-relation between the clinical diagnosis and actual cause established post-mortem.  Legal issues will arise as to whether a particular traumatic event has a causal relationship with the cause of death as PTE. Establishment of the cause of death (COD) as PTE, timing of the thrombotic event in relation to an ante-mortem trauma and exclusion of medical negligence on the basis of misdiagnosis and missed diagnosis are some important medico-legal issues encountered by the forensic pathologist. The objective of this case presentation is to elaborate practical difficulties encountered by the pathologist in addressing above medico-legal issues. The death of a 46-year-old male bike-rider from PTE, who died three days after being discharged from the hospital on the 26th day following a traffic accident resulting in multiple rib fractures and severe abdominal trauma which warranted splenectomy is discussed here.


Download data is not yet available.


Amendola, L. & Optd, (2019). Neglected pulmonary thromboembolism in a traumatic anterior hip dislocation: A case report. J Clin Orthop Trauma 197–200. DOI: https://doi.org/10.1016/j.jcot.2019.02.005

Dzidzava, I. I., Kotiv, B. N., Makhmudov, K. I., Barinov, O. V., Zubarev, P. N., Smorodskij, A. V., Stolnikov, M. A., Slobodyanik, E. V. & Shchemelev, A. A. (2021). Treatment of massive pulmonary embolism with systemic thrombolysis in the nearest postoperative period. Grekov's Bulletin of Surgery 179(5), 63–68. Retrieved from https://dx.doi.org/10.24884/0042-4625-2020-179-5-63-68 10.24884/0042-4625-2020-179-5-63-68 DOI: https://doi.org/10.24884/0042-4625-2020-179-5-63-68

Eom, J. H. & Jysckhtk, (2014). A study of pulmonary thromboembolism after head and neck surgery. Korean J Otorhinolaryngol-Head Neck Surg 533. DOI: https://doi.org/10.3342/kjorl-hns.2014.57.8.533

Fineschi, V. & Tenmpcri, (2009). Histological age determination of venous thrombosis: a neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int 22–30. DOI: https://doi.org/10.1016/j.forsciint.2009.01.006

Gudipati, S. & Fecvhsspknea, (2014). A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients. BMC Med 39. DOI: https://doi.org/10.1186/1741-7015-12-39

Hope, W. W. & Dbnwstslhbea, (2007). Postoperative pulmonary embolism: timing, diagnosis, treatment, and outcomes. Am J Surg 814–822. DOI: https://doi.org/10.1016/j.amjsurg.2007.08.014

Kerkez, M. D., Ćulafić, Đ. M., Mijač, D. D., Ranković, V. I., Lekić, N. S. & Stefanović, D. Ž. (2009). A study of pulmonary embolism after abdominal surgery in patients undergoing prophylaxis. World Journal of Gastroenterology 15(3), 344. Retrieved from https://dx.doi.org/10.3748/wjg.15.344 10.3748/wjg.15.344 DOI: https://doi.org/10.3748/wjg.15.344

Kumar, V. & Kaca, (2018). Robbins basic pathology. Ch. The lung;. 10th ed. Kumar V KACA, editor. Philadelphia. In Robbins basic pathology. Ch. The lung ( Kumar V KACA , Ed. ). Elsevier

Mansueto, G. & Cdcevfbgcrea, (2019). The dating of thrombus organization in cases of pulmonary embolism: an autopsy study. BMC Cardiovasc Disord 250. DOI: https://doi.org/10.1186/s12872-019-1219-8

M. R. (2013). Testing in cases of unexplained pulmonary thromboembolism and atherosclerosis at autopsy? Forensic Sci Med Pathol 575. DOI: https://doi.org/10.1007/s12024-013-9463-1

Rich, N. M., Mkha, & Trauma, . V. (2004). Vascular Trauma.. 2nd ed. London. London: W B Saunders:

Sane, M. R. & Zkma, (2013). Limitations in autopsy diagnosis of fatal pulmonary thromboembolism in indian setup. Science and Law, A Journal of Medicolegal Association of Maharashtra 2.

Saukko, P. J. & Kb, (2015). Knight’s forensic pathology fourth edition [Internet]. 4th ed. London. In Knight’s forensic pathology fourth edition ( Internet]. 4th ed. London: Hodder Arnold Available , Ed. ). Retrieved from http://dx.doi.org/10.1201/b132662

Shonyela, F. S., Yang, S., Liu, B. & Jiao, J. (2015). Postoperative Acute Pulmonary Embolism Following Pulmonary Resections. Annals of Thoracic and Cardiovascular Surgery 21(5), 409–417. Retrieved from https://dx.doi.org/10.5761/atcs.ra.15-00157 10.5761/atcs.ra.15-00157 DOI: https://doi.org/10.5761/atcs.ra.15-00157

(2010). Management of acute pulmonary embolism New York. In Management of acute pulmonary embolism ( S K , Ed. ). Humana Press

S. C. (2007). Complications in Surgery and Trauma. Informa Medical. Complications in Surgery and Trauma. Informa Medical .

Starr, A. J. & Szspsdeaabea, (2019). Significant reduction of pulmonary embolism in orthopaedic trauma patients. J Orthop Trauma 78–81. DOI: https://doi.org/10.1097/BOT.0000000000001346

von Both, I., Bruni, S. G. & Herath, J. C. (2018). Differentiation of antemortem pulmonary thromboembolism and postmortem clot with unenhanced MRI: a case report. Forensic Science, Medicine and Pathology 14(1), 95–101. Retrieved from https://dx.doi.org/10.1007/s12024-017-9940-z 10.1007/s12024-017-9940-z DOI: https://doi.org/10.1007/s12024-017-9940-z



How to Cite

Hulathduwa, S. R., & Wijesinghe, B. P. (2021). PULMONARY THROMBO-EMBOLISM: DIFFICULTIES ENCOUNTERED IN ESTABLISHING CAUSAL RELATIONSHIP AND EXCLUDING THERAPEUTIC MISMANAGEMENT-A CASE REPORT. International Journal of Research -GRANTHAALAYAH, 9(4), 150–160. https://doi.org/10.29121/granthaalayah.v9.i4.2021.3838