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

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

3. Material and methods Retrospective study - autopsy material – 2009 – 2013 Department of Pathology of Emergency County Hospital of Tîrgu-Mure, Romania – 2009-2014 Annually number of necropsy – number of PE Patient’s age and gender Concordance of clinical and post-mortem diagnosis

4. 58% n=41 Results 2009-2013 – 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

6. 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

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

8. Concordance based on the deceased`s clinical origin

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

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

11. Discussion 2630 autopsies (2004-2013) - 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]

12. 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