SLIDE 1 THE RADIOLOGY VORTEX
SCBT-MR 2012 Missed Case Presentation Matthew S. Davenport, M.D.
SLIDE 2 Background
- 70 year-old male
- Anorexia, pleuritic chest pain, malaise,
weight loss
- PMHx: HTN, GERD, Hypercholesterolemia
- Former smoker
- CT chest / abdomen was performed
SLIDE 3
CE-CT, 2/18/2010 CT Chest / Abdomen, 3/6/2012
HU: 20-22
SLIDE 4
CE-CT, 2/18/2010 CT Chest / Abdomen, 3/6/2012
HU: 20-22
SLIDE 5
My erroneous report:
SLIDE 6
Testicular Ultrasound 3/7/2012
SLIDE 7
Neck CT 3/16/2012
SLIDE 8
Neck US 3/28/2012
SLIDE 9
CT-guided Biopsy 4/5/2012
SLIDE 10
CT-guided Biopsy 4/5/2012
SLIDE 11
Upper Endoscopy 6/18/2012
SLIDE 12
Many clinic visits ensued. Short-term follow-up imaging was performed.
SLIDE 13
Abdomen CT 5/11/2012 Abdomen CT 7/25/2012
SLIDE 14
Abdomen CT With 3/6/2012
SLIDE 15
Abdomen CT Without 7/25/2012 Abdomen CT With 7/25/2012
SLIDE 16 The Fallout (so far)
- 1 US testes
- 1 CT-guided biopsy
- 2 CT abdomen / pelvis
- 1 CT neck
- 1 US neck
- 2 Upper endoscopy
- 1 Gastroenterology consultation
- 19 Clinical Notes and/or visits
= Incalculable patient anxiety
SLIDE 17
The Fallout
US-GUIDED THYROID NODULE FNA REQUSITION IS NO DOUBT FORTHCOMING
SLIDE 18 Follow-up
- The patient eventually admitted to self-
medicating his recurrent back pain with high-dose internet-ordered prednisone
- The working diagnosis is non-solid fluid
collections, such as resolving abscesses or pseudocysts
SLIDE 19 Follow-up
– Craniocaudally oriented elliptical fluid collections can appear round on axial imaging – Not all “masses” are neoplastic – If we point the “ship” in the wrong direction, it can be a long expensive journey before it finally reaches port
