SCBT-MR 2012 Missed Case Presentation Matthew S. Davenport, M.D. THE RADIOLOGY VORTEX
Background • 70 year-old male • Anorexia, pleuritic chest pain, malaise, weight loss • PMHx: HTN, GERD, Hypercholesterolemia • Former smoker • CT chest / abdomen was performed
CT Chest / Abdomen, 3/6/2012 CE-CT, 2/18/2010 HU: 20-22
CT Chest / Abdomen, 3/6/2012 CE-CT, 2/18/2010 HU: 20-22
My erroneous report:
Testicular Ultrasound 3/7/2012
Neck CT 3/16/2012
3/28/2012 Neck US
CT-guided Biopsy 4/5/2012
CT-guided Biopsy 4/5/2012
Upper Endoscopy 6/18/2012
Many clinic visits ensued. Short-term follow-up imaging was performed.
Abdomen CT 7/25/2012 Abdomen CT 5/11/2012
Abdomen CT With 3/6/2012
Abdomen CT Without Abdomen CT With 7/25/2012 7/25/2012
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
The Fallout US-GUIDED THYROID NODULE FNA REQUSITION IS NO DOUBT FORTHCOMING
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
Follow-up • Take-home points: – 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
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