AUTHOR: POP MARIA CRISTINA COAUTHOR: SIMON MELANIA RENATA COORDINATORS: IOAN JUNG, SIMONA GURZU

Pulmonary embolism (PE) - common cardiovascular emergency Acute life-threatening Non-specific clinical presentation → PE difficult diagnosis Discordant clinical-autopsy cases Introduction

Material and methods Retrospective study - autopsy material – 2009 – 2013 Department of Pathology of Emergency County Hospital of Tîrgu-Mure, Romania – Annually number of necropsy – number of PE Patient’s age and gender Concordance of clinical and post-mortem diagnosis

58% n=41 Results – 1130 autopsies 71 deaths (8.02%) – pulmonary embolism  ≤ 45 years - M:F = 1.8:1  > 45 years – M:F = 1:1.7  p<0.0001

Origin of the thromembolus  16 cases (22.53%) - deep vein thrombosis  18 cases (25.35%) - iatrogenic causes - postoperative complications (laparotomy, cardiac surgery, femuro–popliteal by-pass)  37cases (52.12%) – other causes - hematological disorders (i.e. aplastic anemia) - aortic dissection - stroke - cardiomyopathies

Concordance of clinical and post-mortem diagnosis Concordant diagnosis – 20 cases Total discordant diagnosis – 32 cases Partially discordant diagnosis – 19 cases

Concordance based on the deceased`s clinical origin

Clinical diagnoses in discordant cases  Septic-, post-hemorrhagic shock  Intestinal infarction  Bronchopulmonary carcinoma with pyothorax  Postoperative complications - post-laparatomy - post-implantation of prostheses - coxarthrosis

Pulmonary thromboembolism (deep vein thrombosis of the leg ) 54 years-old male Clinical diagnosis: Myocardial infarction 16 cases – 4 cases (25%) were concordant

Discussion 2630 autopsies ( ) - The most common missed diagnoses were pulmonary embolism (30.61%), acute myocardial infarction (25.51%), aortic dissection (22.45%), stroke (8.16%), and cardiac failure (8.16%) [Gurzu S et al. Exp Clin Cardiol J, 2014] The most common major discrepancies, in large cohorts non-divided on specific group of patients, proved to be observed for myocardial infarction, pulmonary embolism, and pneumonia [ Kuijpers et al. J Clin Pathol. 2014]

CONCLUSIONS The large number of diagnostic discrepancies indicates that autopsy remains a valuable tool to identify the missed diagnoses in cases with pulmonary thromboembolism Pulmonary embolism remains one of the main causes of death in hospitals, with a significant rate of undiagnosed cases. The clinico-necroptic correspondence represents an inhospital quality assessment, reflecting the diagnosis accuracy The estrogen protection in women of childbearing age could explain the low prevalence of pulmonary embolism in young females that do not use contraceptive pills