Wednesday, October 31, 2012

Can you guess the diagnosis using this radiology report?



Here are some excerpts from a radiology report I received. I left out some portions that were not pertinent and I highlighted in bold some of the better parts. My comments are in brackets.

This was in reference to a CT scan of the abdomen for abdominal pain.

Free peritoneal air is present. Proximal small bowel loops are dilated to about 4 cm in diameter. In the lower abdomen and upper pelvis there is a region of edema and a change in caliber of the diameter of the bowel consistent with bowel obstruction. This edema also surrounds the sigmoid colon. There are diverticula and diverticulitis is a consideration. Perforated diverticulitis is also another consideration for the free air. There are some collections of air along the right side of the sigmoid colon which may be extraluminal or perhaps some prominent diverticula. A small abscess in this region is a consideration. There is diffuse edema in the lower omentum.

No abnormal masses are seen in the pelvis. No significant amount of free pelvic fluid is present. {Is there an insignificant amount of fluid?]

No appendicitis. No diverticulitis. No free air.[!]

IMPRESSION: Proximal small bowel obstruction. Questionable diverticulitis with questionable small abscess adjacent to the sigmoid colon. Pneumoperitoneum [“Pneumoperitoneum” means free air in the abdominal cavity.]

Is there diverticulitis? Is there free air? What the hell is going on?

So if you were the surgeon, what would you do?

At least the radiologist used the correct plural form of the word “diverticulum.” See my previous post on this topic.


12 comments:

Rachel J. Kwon said...

I think the diagnosis is malignant dictation software.

surgeon s. said...

a picture is worth a thousand words...this radiologist just used all the words he/she had. i defer my judgement without seeing actual pictures (as all surgeons likely do).

Kasia said...

I'd have a look at the pictures. Obviously the radiologist was tired or working on two cases at a time. Where's the free air go? Diverticula there and gone too?

Marianne Foderetti said...

I'd say the radiologist was an idiot. I would have to look at the pictures myself, like everyone else has said. But then I would have to have a come-to-Jesus with the asshat who used every term he/she learned in med school while interpreting my patient's CT!

docster said...

I'd say that a lot of the cases in radiology fall in the grey area, but then there are also a quite a lot of radiologists who don't like to put themselves on the line even if they know better.

GlynDMD said...

Endometriosis of the sigmoid colon. http://radiographics.rsna.org/content/21/1/193/F35.expansion.html

Anonymous said...

"Can you guess the diagnosis using this radiology report?" As a patient I get nervous when I hear a doctor say "guess". :-)

Skeptical Scalpel said...

Sorry about the delay in responding. I just got power back after the hurricane.

Thanks for the comments. I agree that a surgeon must look at all the images. I hope it was just a bad day for this radiologist.

Anonymous, I don't want to upset you, but we guess more often that you might think. Unlike TV doctors, we don't always figure it out in 53 minutes. At times, you have to go with your best guess and do something.

Anonymous said...

-Poorly edited copy and paste report.

-I'll agree that endo should be considered more than it ever is tho.

-SCRN

Skeptical Scalpel said...

SCRN, I think he's a victim of speech recognition plus failure to proofread before verifying.

krankenmeister said...

The radiologist's favorite plant?...the hedge, of course!

sinu said...

am sure none of here faced a scenaro like this 22 year female lump in abdomen work up- CECT referral form - No UPT !!!

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