Medicamentous thrombolysis disguises pulmonary thromboembolism as a cause of death

In this case report, we report on a 31-year-old female patient who was admitted to emergency department with symptoms of cardiac arrest and ultimately died in spite of enormous resuscitation efforts. During resuscitation, pulmonary embolism was considered as a possible noncardiac cause of cardiac arrest and following its extremely unfavorable prognosis ; the fatal outcome was not so surprising. However, since acute pulmonary emboli obstructing blood flow to a lobe or multiple lung segments was suspected, alteplase was indicated and administered. On the autopsy, no venous thrombosis in the vena cava, pelvic veins, or any of the lower extremity veins was documented ; conversely, neither specific sign of pulmonary thromboembolism (PTE) was found macroscopically, until it was confirmed by histopathological staining that is not used as a routine diagnostic tool. In this study, we conclude that PTE is generally overlooked as the principal diagnosis and the cause of death. Rightful postmortem diagnosis could lead to increased vigilance and a change in management in many of such cases, what could result in improved survival. Motivated by providing better awareness of PTE, this study aimed to illustrate unrecognized PTE and pathological findings that were masked by thrombolytic drugs