Page 35 - Diagnostic Radiology - Interpreting the Risks Part One

SVMIC Diagnostic Radiology: Interpreting the Risks

CASE STUDY

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 ear ache.

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

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