Clinical Diagnostics; Experience From 383 Autopsied Cases

Abstract. The aim of the present study was to investigate whether the experience of clinical diagnostics could still further be enriched through routine autopsies. The question was studied by comparing diagnoses made by the same clinicians before and after autopsy in 383 subjects. Clinical misinterpretations thereby revealed were further analysed and described. Acute myocardial infarction (AMI) was the most common main cause of death. The diagnosis was seldom disproved when clinically considered fairly certain, but the disorder had often been missed ante mortem, especially among patients with known chronic ischaemic heart disease (IHD). Hidden behind this latter label were also cases with valvular lesions or with lung disorders and right heart failure. Apart from chronic IHD, cerebrovascular diseases were clinically overdiagnosed as main cause of death; sometimes recent myocardial infarcts or malignant neoplasms were instead disclosed at autopsy. Clinical diagnoses of neoplastic disorders were seldom found to be erroneous, but malignancy should be more often considered clinically. In several cases where it had been impossible to establish a definite diagnosis on clinical grounds acute abdominal disorders were revealed post mortem. An increased suspicion as regards these diseases seems warranted in obscure cases. The misinterpretations were frequently a consequence of our tendency to stick to earlier diagnoses and to overlook the development of new signs and symptoms. The same mechanism might partly explain why disorders contributing to death had often been unrecognized clinically —most frequently pulmonary embolism, AMI, cirrhosis of liver, and ulcer of stomach or duodenum. It is concluded that the Latin epigram regarding autopsies is still valid: “Mortui vivos docent”, let the dead teach the living.