Page 36 - Diagnostic Radiology - Interpreting the Risks Part One

SVMIC Diagnostic Radiology: Interpreting the Risks

CASE STUDY

continued
two days later and the cause of death was listed as cerebral

edema and cerebral abscess.

The strong points included that the radiologist specifically

identified mastoiditis as a concern, and he advised clinical

correlation. The radiologist also noted that the post-contrast
image “may be beneficial” for further evaluation. Also,
CT of the temporal bones “may be beneficial” to further

evaluate for boney coalescence. However, the radiologist’s

comments about “may be beneficial” conveys something
that is not absolute. The phrase is similar to recommending
the test. The way the clinician interpreted the overall note is

that clinical correlation was suggested. If mastoiditis were

a concern, the post-contrast imaging and CT scan of the
temporal bones would be the test the radiologist would
order. Whether the radiologist “recommends” follow-up

testing or thinks follow-up testing “may be beneficial”, it

is still up to the attending physician. But, in this case, the
words chosen did not convey to the attending physician
the urgent need to order the follow-up testing.

As a defense expert observed, the problem with a radiology

case like this is that the plaintiff can put up specific images
and show where there are areas of whiteness. Although

our experts can explain that these findings are subtle, or
explain by averaging or artifact, the problem is that lay

people can see the whiteness on the images.
It may be difficult for them to look past the

whiteness when there are experts on the
plaintiff’s side who are pointing to it and

saying the whiteness represents edema.

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