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Liver laceration during biopsy leads to fatal hemorrhaging.

Byline: Mass. Lawyers Weekly Staff

On Feb. 22, 2013, the plaintiff's decedent, 49, was found to have an enlarged liver with multiple lesions. An abdominal CT on March 5, 2013, further defined the lesions, showing the largest in the anterior right hepatic dome.

On March 18, the plaintiff's decedent underwent a CT-guided liver biopsy performed by the defendant radiologist. The decedent was found to have cirrhosis with no malignancy.

Approximately 10 minutes after concluding the biopsy, the decedent developed 10/10 abdominal pain, diaphoresis and nausea. Blood pressure dropped to 103/68 and pulse dropped to 61. Respiratory rate rose to 28. The pain level was repeatedly recorded as 10/10 during the next 50 minutes. The patient remained hypotensive throughout; the symptoms were consistent with intraabdominal hemorrhage from the liver biopsy site.

The defendant radiologist performed a post-procedure ultrasound and reported that it showed trace perihepatic fluid. The plaintiff's expert opined that it actually showed diffuse hypoechoic material surrounding the liver which was not present on the prior ultrasound performed on Feb. 26, 2013 consistent with a large volume of clotted blood.

More than an hour after the biopsy, the decedent was taken to the Emergency Department in extremis. The ED physician noted that there had been no sign of bleeding on the ultrasound performed by the defendant. After approximately 30 minutes, the decedent suffered a fatal cardiac arrest.

At autopsy, the pathologist concluded that the cause of death was "[c]omplications of hemoperitoneum (blood in the peritoneal cavity) following a recent liver biopsy procedure in a patient with liver cirrhosis." He noted a capsular tear of 1.1 cm in length with varied depths of 0.3 to 1.2 cm in the anterior, right liver.

The plaintiff's claim was that it was well-understood that hemorrhage was a potential complication of liver biopsy and that the accepted standard of care at the time required the average qualified radiologist to observe certain precautions during the procedure in order to minimize the risk of hemorrhage.

The plaintiff claimed the defendant violated the standard of care when he selected for biopsy a lesion too close to the liver capsule; when he placed the needle in such a way as to tear the capsule; and when he failed to report correctly findings consistent with a large volume of clotted blood on the post-procedure ultrasound, depriving ED providers of critical information.

The plaintiff's position was that, as a consequence of the substandard care, the decedent suffered a laceration of the liver and liver capsule, hemorrhaged and died.

The case settled for $700,000 before the disclosure of defense expert opinions.

Action: Medical malpractice

Injuries alleged: Death

Case name: Withheld

Court/case no.: Withheld

Jury and/or judge: N/A (settled)

Amount: $700,000

Date: April 4, 2018

Attorneys: Chanise R. Anderson and Suzanne C. McDonough, of Keches Law Group, Milton (for the plaintiff)

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Publication:Massachusetts Lawyers Weekly
Date:Aug 9, 2018
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