Limitations in Autopsy Diagnosis of Fatal Pulmonary Thromboembolism in Indian Setup

Pulmonary thromboembolism (PTE) caused due to deep vein thrombosis (DVT) is an important cause of sudden natural death; however it is a commonly missed diagnosis at autopsies in Indian setup. This is a well-recognized complication of recumbency following trauma, especially fractures and surgical operation or prolonged bed rest in medical cases. However in some cases, no apparent predisposing condition is identified. In such cases, occult hereditary thrombophilias may play a causal role. In the present case, an apparently healthy young man became suddenly unconscious while kick starting his motorcycle. He was immediately rushed to the hospital where he died during treatment within 3 hours of admission. His autopsy showed presence of deep vein thrombosis with pulmonary emboli. Histopathological examination of lungs revealed presence of pulmonary infarction and dating of residual leg vein thrombus indicated a thrombus of not more than 3 days. He was apparently healthy, without any predisposition for deep vein thrombosis. Fatal pulmonary thromboembolism with pulmonary infarct in such a young, healthy person without any predisposition of common risk factors is an unusual occurrence. This case emphasizes the need for improved methodology including dating of residual thrombus in leg veins and postmortem testing for hereditary thrombophilias in death of young people due to PTE.