Page 31 - 2022 Risk Basics - Radiology

SVMIC Risk Basics: Radiology

C A S E S T U DY

A 44-year-old male presented to the emergency department

where a CT scan revealed mastoid and middle ear infections.

The patient was transferred to a tertiary facility with complaints
of fever, headache, and earache. Blood cultures were performed,
which showed gram positive cocci in clusters in one of the two

blood cultures. An MRI of the brain and brain stem with contrast

was ordered and interpreted by the radiologist.

The radiologist noted that there was no definite evidence to
suggest recent infarction or recent intraparenchymal hemorrhage.

There were no discreet intra-axial masses identified. The ventricles
were normal in size and symmetry. The craniocervical juncture

was grossly unremarkable. The upper-cervical spinal cord was
unremarkable. Incidental note was made of large fluid accumulation

within air cells in the right ear raising concerns of mastoiditis, and
clinical correction was advised. The radiologist listed the following

as his impression: “Large fluid accumulation is noted within the
mastoid air cells in the right raising concerns for mastoiditis. Clinical

correlation is advised. Post-contrast imaging may be beneficial
(emphasis supplied) for further evaluation. Additionally, CT scan

of the temporal bones may be beneficial (emphasis supplied) to
further evaluate for boney coalescence.” No phone call was made

to the attending physician.

The patient was discharged from the hospital with Tylenol #3 and

Augmentin for the ears and instructed to return to the hospital if
more symptoms developed. The patient died two days later, and the

cause of death was listed as cerebral edema and cerebral abscess.

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