Massive Pulmonary Embolism Presenting as Acute Liver Failure in a Young Woman

Key finding

The liver was reporting a haemodynamic event and the report was read as a hepatic one. The transaminases were real, severe, and correctly measured. What they meant was misread. This is a wrong-organ error rather than a missed-abnormality error, and it is arguably more dangerous than a normal test, because a catastrophically abnormal result generates urgency directed at the wrong target. The stakes of the misdirection are unusually asymmetric. Massive pulmonary embolism is treated with systemic thrombolysis, catheter-directed therapy or embolectomy — all time-critical, all measured in hours. Acute liver failure is managed with supportive care, N-acetylcysteine, and transplant assessment. A patient being worked up for hepatic causes — viral serology, autoimmune panels, paracetamol levels, toxicology — is not being worked up for a disease where the therapeutic window is a few hours wi

Framework connections: The Missing Mechanics (EPCs), The Burn and Crash Model

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