36-year-old woman would still be alive if her aneurysm was spotted, coroner concludes.

The coroner said Lucy Cziraki would likely still be alive had the aneurysm been spotted by medical professionals. 

Lucy died aged 36 in October 2023, of a ruptured aortic root aneurysm – a serious and life-threatening condition where part of the main artery carrying blood from the heart bursts, causing severe internal bleeding. She attended A&E five days before she died complaining of severe chest pain but was discharged home after three days. 

The inquest into Lucy’s death was held over four days at North West Kent Coroner’s Court and concluded on 13 June 2025. 

HM Coroner Catherine Wood found that there was a missed opportunity to diagnose and treat Lucy, who had a history of vasculitis (inflammation of the blood vessels) and was being monitored for an aneurysm at the aortic root.  

She started suffering from severe chest pain on 29 September 2023 while she was at home. She was taken to A&E at Pembury Tunbridge Wells Hospital by her husband. An urgent CT scan of Lucy’s aorta was requested, but the referral for the scan did not mention Lucy’s aortic root aneurysm.  

The inquest heard that a scan was undertaken, and the images were transferred to an external radiology company, Telemedicine Clinic. The reporting radiologist at the external company did not have access to previous imaging of Lucy’s heart and was not made aware of the aortic root aneurysm. The scan was reported as showing no signs of concern.   

Lucy was kept in hospital and further investigations were carried out to try to identify an alternative cause for her symptoms. It was thought that she was suffering from inflammation, and she was prescribed steroids and anti-inflammatory medication and was discharged. 

The court heard that three days after she was discharged, Lucy woke up in extreme pain and collapsed at home. Attempts at resuscitating her were made and an ambulance was called but Lucy died that morning. 

HM Coroner Catherine Wood found that the not all of the information that should have been on the request form for Lucy’s CT scan were provided and that this was compounded by the fact that the radiologist analysing the imaging did not have access to Lucy’s previous scans. 

The coroner also found that the radiologist should have indicated in her report that there were problems with the imaging that was taken of Lucy and that it was not possible to rule out an acute problem with her aorta.  

The coroner added that if further imaging had been undertaken the problem with Lucy’s aorta would have been identified, and Lucy would have been transferred for emergency surgery and, on the balance of probabilities, would have survived.  

The coroner will be writing a Prevention of Future Deaths report to the Department of Health highlighting her concerns about the sharing of radiology imaging between NHS hospitals and external radiology companies.  

Lucy’s family are represented by Leigh Day solicitor Ceilidh Robertson. 

Lucy’s family said: 

“Tragically, the circumstances surrounding Lucy’s untimely death have left a profound void in the lives of those who loved her. It is important that we remember her not just for the pain of her loss, but for the extraordinary person she was. Her legacy of love, kindness, and resilience is one that will continue to resonate through the lives she touched. 

“Through the Inquest process we hoped to honour Lucy’s memory and seek the truth about her death. We sought not only justice for her but also to ensure that the lessons learned from her case can prevent similar tragedies in the future. Lucy deserved the best care, and it is our commitment to advocate for her and others who may be vulnerable to these situations.” 

Ceilidh Robertson said: 

“This Inquest has been incredibly difficult for all those involved. The process has facilitated a thorough investigation into Lucy’s death and found that Lucy would likely still be alive had she received different care. 

“It is encouraging that the coroner has decided to issue a Prevention of Future Deaths report to the Department of Health, and I sincerely hope that action is taken and lessons are learned so that no other families have to experience such a devastating loss.”