Page 46 - Diagnostic Radiology - Interpreting the Risks Part One

SVMIC Diagnostic Radiology: Interpreting the Risks

CASE STUDY

A 21-year-old female nonsmoker with a history of pregnancy-
induced hypertension, approximately six months post-partum,

presented to her PCP on April 18 with a productive cough
(worse at bedtime), chest tightness, and shortness of breath

with ambulation x3 weeks. Blood pressure was 100/80, pulse
was 108, and lungs were clear. She was diagnosed with
bronchitis and prescribed antibiotics and cough medicine. On

April 23, the patient presented to the emergency department

with similar complaints except she was now coughing up
blood. On examination, lungs were auscultated with rales
noted in the left lung. A CXR and CBC were ordered by the

emergency department physician. The radiologist, who was
located at a different facility across the state line, reviewed

the CXR and dictated, “biventricular cardiac enlargement
consistent with cardiomyopathy”.

The radiologist immediately telephoned the ED and spoke

to a nurse who wrote the results on the demographic sheet
next to the order for the CXR. A copy of the radiology report
was received in the ED within 30 minutes. However, the

emergency physician, who was going off shift, did not review
the results, despite signing both the CXR order and the

demographic sheet (it is unknown at what time he signed
the sheet or the nurse wrote the report, as there was a shift

change). The patient was discharged after the call and the
report was received with a diagnosis of “persistent bronchitis”.

The patient died four days later from congestive heart failure.
The emergency physician, the hospital, and

the radiologist were all sued. Ultimately, the
radiologist was dismissed from the suit and

a large settlement was paid on behalf of the
remaining defendants.

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