This case involves a male patient who presented to the emergency room complaining of chest pain and shortness of breath. An EKG, chest x-ray, and other testing was done yielding normal results. After a short time, the patient was discharged from the hospital on and advised to follow up with his primary care physician. A few days later, the patient saw  his primary care physician who ordered additional pulmonary function tests.  The patient returned to his primary care doctor a few days later, where he was told that his tests had come back and seemed to indicate chronic obstructive pulmonary disease. The doctor ordered a CT chest for the patient, however the patient was found dead in his home before the test could be conducted.  An autopsy was later performed which revealed acute pleuritis and empyema and pulmonary emphysema.
Question(s) For Expert Witness
- 1. Are the clinical signs and symptoms associated with this disease usually detected by a physical exam, vitals and patient history?
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2. Is an earlier detection and intervention of the pathologies described in this case associated with a better outcome for a patient?
Expert Witness Response E-006953
The clinical signs and symptoms of pleuritis, empyema, and emphysema are usually detected by history and physical exam, especially if the conditions are moderate or severe. In mild cases, further diagnostic testing may be required to make the diagnosis. Earlier detection of these conditions and appropriate intervention is usually associated with a better outcome. In this case, I would need to review the clinical and autopsy data to determine if there was a breach in the standard of care. The key question is whether the CT scan should have been ordered and completed earlier (either in the Emergency Department or urgently by the PCP). A second question would be whether the Emergency Department or the PCP provided a reasonable differential diagnosis to explain the patient’s chest pain and shortness of breath. Sudden death is often caused by pulmonary embolism and is less likely to be caused by pleuritis, empyema, and emphysema. I have lectured on the topic of pulmonary embolism and emphysema. I frequently teach residents and students about these conditions. I have never been the target of a malpractice claim. I have never been sued or arrested.
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