Case Archive
Cardiology, Emergency Medicine,
Radiology, Cardio-Thoracic Surgery

Ref. # 16918

A 49 year old Massachusetts man, 100 lbs overweight, presented to the ER with severe inter-scapular chest and back pain and leg weakness, where he was evaluated by a non-boarded ER physician. The patient was hypertensive to 228/110. EKGs were normal. The ER physician suggested admitting the patient to the ICU. He was overruled by an internist, who examined the patient and ordered a ventilation perfusion lung scan, which was subsequently reported as low probability for pulmonary embolism. The patient was given nasal oxygen and nitroglycerin paste. Four and a half hours after admission, the patient was given Tylenol and discharged by the ER physician, pursuant to the internist's instructions. A half hour after the discharge, the ER physician overheard that a radiologist interpreted the chest X-ray as showing plate-like atelectasis left lung base, tortuous ectatic thoracic aorta and prominent great vessels. Shortly after this, the patient died at home from an acute dissection of the ascending aorta with pericardial tamponade. A medQuest cardiologist and emergency medicine specialist independently reported that, in light of the patient's signs and symptoms, the standard of care required a differential diagnosis which included aortic dissection. As an MI and pulmonary embolus had been ruled out, there was a negligent failure to admit the patient for further evaluation. A medQuest radiologist reported that even if the chest X-rays were normal, standard of care required admitting the patient for a C-T scan, in light of his age, weight, and symptoms. A medQuest cardio-thoracic surgeon reported the patient more likely than not would have survived with timely surgery, with a five-year survival rate of 85%-90%.

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