A pensioner who attended Bradford Royal Infirmary suffering chest pains died while waiting for a CT scan, an inquest has heard.
Lilly Russell, 67, of Woodend Court, West Bowling, was in such pain she could not wait for an ambulance and took herself to A&E.
Doctors admitted her to a medical assessment ward after “a bizarre-looking” chest X-ray came back and they suspected it showed a malignant tumour.
But the white-out area in the X-ray was in reality an aneurysm in her aorta which unexpectedly burst three days later, killing her suddenly.
A CT scan would have got her a quicker diagnosis – although people suddenly found to have aneurysms as big as hers with no symptoms would only be expected to live without treatment for about six months, the hearing in Bradford was told yesterday. Mrs Russell had hardened arteries and the aneurysm could have been developing for several years. The pain that worsened on June 23, 2012, would have come from her split aorta leaking blood into her chest cavity, collapsing one of her lungs.
She died on June 25 due to the rupture.
The inquest heard from an independent expert medical witness, John Scare, a consultant in vascular surgery, that if Mrs Russell had received an earlier CT scan revealing the aneurysm she would have had the option of open surgery.
But it would have been risky – not just the transfer journey to Leeds General Infirmary but also that the chances of her surviving the procedure would only have been about 30 per cent.
He said the rupture could have happened at any time and when it did happen she would not have known anything about it.
Her condition was not a common one and was extremely difficult to diagnose.
Her symptoms were not typical as usually the associated pain is in the back and can go up to the jaw, which she did not complain of, Mr Scare told the inquest.
Doctors had decided on the Saturday, the day after she was admitted, that a CT scan could wait until the Monday because she seemed well enough on the ward. But they were not aware she had been hypotensive when her blood pressure had dropped, and neither had a set of blood count results been reviewed which would have shown she had lost one pint of blood – which, according to Mr Scare, could have been “one little piece of jigsaw that might have increased the urgency of a CT scan.”
The doctors also had the distraction that she had lost about one stone in weight, and there was a working diagnosis that the mass in the X-ray was cancer, said Mr Scare.
Assistant Bradford Coroner Dr Dominic Bell asked consultant radiologist Gemma Smith if there had been any barriers to doing the CT scan on the Saturday.
She replied: “Not at all. It was based on a clinical discussion.”
She added: “My understanding was Mrs Russell was stable, not acutely unwell. We felt at the time the CT scan could be done on the Monday. If we felt it needed to be done sooner it would have been.”
The hearing continues.