A medical malpractice case about communication failures around imaging: 🧵

A young, very tall man with chest pain, nausea, and abdominal pain presented to the ED and was worked up by the emergency physician. Concerned about possible Marfan syndrome and the risk of aortic dissection, the ED doctor ordered a STAT noncontrast chest and abdominal CT, worried that contrast might worsen his elevated creatinine.

The callosal angle in possible iNPH assessment is measured on a coronal plane perpendicular to the anterior commissure-posterior commissure line, at the level of the posterior commissure.
The technique is demonstrated erroneously in this #journalimage
doi.org/10.1056/NEJMra… Small angular deviations significantly change the measured callosal angle.

The yellow is the correct one.

doi.org/10.1007/s00234…

Failure to effectively communicate

A teen presented to the ED with chest pain and dyspnea. A CXR was reported below.

The patient/family were led to believe it was normal and were discharged home.

He died 3 days later.

Parents sued. Hospital just settled for $16 million. 🧵 Autopsy indicated the cause of death was complications of mediastinal T-cell lymphoblastic lymphoma. Had the CXR-evident mediastinal adenopathy been properly communicated, worked up, and managed in the hospital setting, plaintiffs alleged, the pt would still be alive.

Reading this malpractice case, part 2: expert witness statements and deposition testimony from physicians (names redacted)🧵
(part 1, the claim from plaintiffs, quoted)

https://twitter.com/francisdeng/status/1736424175966007577

Noncontrast head CT was performed at 4:08AM.
Reason for study: "R/O bleed"
Wet read given to neurology resident at 4:15AM: no acute intracranial hemorrhage.
Brief prelim report in EMR at 4:33AM.

One of the largest malpractice awards ever just dropped:
"Hospital on the hook for $120M jury verdict after residents miss signs of stroke on CT"


Always interested in learning from diagnostic error, I looked up the court documents.🧵pt1 (names redacted)radiologybusiness.com/topics/healthc… A 41 year old man without significant past medical history is last seen well at 10pm as his wife went to bed (he stayed up to play video games)

He's discovered unresponsive at 3am when the wife is awoken by a loud bang:

"The general rule in acute dizziness and vertigo is that if you need neuroimaging, it should be by MRI, rather than CT."

Pearls and pitfalls in diagnostic stroke in acute dizziness/vertigo: ahajournals.org/doi/pdf/10.116…
🧵for case example👇 This older adult presented to clinic with several episodes of dizziness in the preceding month (off-balance, not room spinning), then a day of gait imbalance, left hand incoordination, and left lip numbness.

Head CT was obtained urgently (Reason: "*Dizziness, non-specific"):

Do the benefits outweigh the risks in using MRI gadolinium-based contrast media (GBCM) in patients with kidney disease?

MAJOR new consensus statement from @RadiologyACR and @NKF published in @Radiology_RSNA at doi.org/10.1148/radiol…

A #RadInTraining #TWEETORIAL thread 👇 BACKGROUND:
GBCMs consist of gadolinium ions chelated with organic ligands to minimize toxicity from free gadolinium.

Which chemical class has a lower rate of free gadolinium dissociation?

You are seeing a patient with suspected #COVID19. When is imaging (CXR or CT) indicated?

A #TWEETORIAL summary of the Fleischner Society consensus statement @Radiology_RSNA: doi.org/10.1148/radiol…
Podcast: doi.org/10.1148/radiol…
#RadsInTraining Step 1: Assess the severity of respiratory disease.

A) is there hypoxemia?
B) is the patient's dyspnea and work of breathing significant?

Acute allergic-like reactions to intravascular iodinated contrast: Who's at risk and how do you reduce the risk?

A #TWEETORIAL for #radres and referring clinicians alike

Inspired by a recent paper in @Radiology_RSNA by Cha MJ, Kang DY, et al. pubs.rsna.org/doi/10.1148/ra… 1/40ish @radiology_rsna First some background:

DEFINING ALLERGIC-LIKE REACTIONS
Which of the following is most likely to represent an allergic-like contrast reaction?