The diagnosis of pulmonary embolism was established during a 6-year period in 284 patients hospitalized in medical departments of a general hospital. Of the 183 patients who died, 178 were autopsied. A retrospective study was performed on the autopsy-verified fatal cases to correlate their clinical state to relevant postmortem findings. Two groups made thorough, independent evaluations of data from the medical and pathological records. In 95% of the patients a confirmed fatal pulmonary embolism constituted only a slight modification of life expectancy, because of concomitant complicating, severe, terminal disease. Reflecting this poor clinical state, only 26 patients (15%) had a diagnosis of pulmonary embolism premortally and of these patient, 13 died within 5 hours after onset of symptoms and 10 were treated with antithrombotic drugs. Our results seem to indicate an increase in the incidence of terminal diseases in the population of elderly, hospitalized patients and change the concept of fatal pulmonary embolism into an agonal incident in a terminal-care medical patient.