Why PEs and DVTs are misdiagnosed
Pulmonary embolism is known as a "great masquerader" — its symptoms overlap extensively with other common conditions. Commonly, breathlessness is misattributed to anxiety, asthma or a chest infection; pleuritic chest pain to musculoskeletal pain or costochondritis; haemoptysis to bronchitis; tachycardia to anxiety or dehydration.
DVT symptoms — unilateral leg swelling, pain, redness and warmth — are commonly attributed to a muscle strain, cellulitis, or superficial thrombophlebitis.
Risk factors (recent surgery, long-haul flight, pregnancy, oral contraceptive use, immobility, malignancy, previous DVT/PE, clotting disorder) must be assessed in any patient presenting with these symptoms.
Clinical standards for DVT and PE assessment
NICE guidance (NG158) specifies:
- Clinical probability scoring (Wells score) to assess DVT and PE probability
- D-dimer testing in low-probability cases to exclude thrombosis
- Proximal leg vein ultrasound for suspected DVT
- CT pulmonary angiography or V/Q scan for suspected PE
- Anticoagulation started in high-probability cases without waiting for imaging
Failure to prevent DVT/PE in hospital
Hospitals must assess patients for VTE risk on admission and prescribe appropriate thromboprophylaxis — low molecular weight heparin, compression stockings, or both. NICE and NHS standards require VTE risk assessment on admission for all patients.
Where a hospital fails to risk-assess a patient, fails to prescribe prophylaxis, or prescribes an inadequate dose, and the patient develops a DVT or PE, a claim may be available.
Post-surgical PE
PE is a known risk of surgery — particularly orthopaedic surgery such as hip and knee replacement. The question for a claim is whether appropriate thromboprophylaxis was prescribed and administered, and whether post-operative symptoms were appropriately investigated.
Common scenarios
PE misdiagnosed as anxiety in A&E
A young woman on the oral contraceptive pill presents with breathlessness and chest pain. Anxiety or a panic attack is diagnosed. D-dimer and CTPA are not performed. She is sent home and dies from massive PE.
DVT missed after orthopaedic surgery
A patient is discharged after hip surgery. Thromboprophylaxis is incomplete or not prescribed. Calf pain and swelling are attributed to a muscle strain by the GP. A DVT is not diagnosed. The patient develops a PE.
DVT missed in pregnancy
A pregnant patient presents with unilateral leg swelling. It is attributed to normal pregnancy-related oedema. Leg ultrasound is not arranged. The DVT is not diagnosed and progresses to PE.
What do you need to prove?
- Duty of care — automatic in all healthcare settings.
- Breach of duty — failure to apply Wells scoring, arrange appropriate imaging, or prescribe thromboprophylaxis fell below the required standard.
- Causation — the missed DVT/PE caused death, permanent organ damage, or post-thrombotic syndrome that prompt treatment would have prevented.
- Damage — death, permanent lung damage, post-thrombotic syndrome, or other harm.
Frequently asked questions
Can I claim if a PE was missed and my relative died?
Yes. Fatal claims under the Fatal Accidents Act 1976 are available to eligible dependants. The claim must show that the PE was missed due to a failure below the required standard.
Can I claim if I developed post-thrombotic syndrome after a missed DVT?
Yes. Chronic leg pain, swelling, and skin changes after an untreated DVT can be the subject of a claim if the DVT was negligently missed.
Can I claim if I was not given DVT prevention treatment in hospital?
Yes. NHS hospitals have a mandatory duty to assess VTE risk and prescribe prophylaxis. Failure to do so, where a DVT or PE results, may give rise to a claim.
Related guides
- Misdiagnosis claims
- A&E negligence claims
- Hospital negligence claims
- Compensation after a death from medical negligence
Sources & further reading
Primary statute, case law and regulator guidance referenced in this article.
- NICE NG158 — Venous thromboembolic diseases — NICE
- Fatal Accidents Act 1976 — UK Legislation