Selected cases will be presented for your evaluation.
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History: A 63 year-old-female reports with low back pain due to a fall approximately 15 days prior.
Findings: Mild to moderate Osteopenia is noted throughout the lumbar spine. Atherrosclerotic plaquing is seen. Sub acute fractures are visualized at L2, L3, L4 left transveser processes.
History: Films were submitted by a local chiropractor of a 37-year-old female. No history of trauma was reported. The attending scheduled an MRI to evaluate a "tumor" he had noted at the T1 vertebrae. A formal report on the plain film study was requested, "to complete the file".
Findings: The study is essentially unremarkable. There is a mild reversal of the C-spine lordosis. Degenerative disc narrowing is present at the C6/C7 disc level. Mild facet arthrosis is also seen in the lower C-spine. No other significant osseous, joint, or soft tissue abnormality is present. The attending's area of concern represents overlie of T1 costotransverse anatomy.
Discussion: The attending stated he occasionally has selected studies overread when he sees "something funny". Unfortunately, in this case, the patient was imaged unnecessarily in the interval. Clinicians who have only selected studies interpreted should rethink this strategy. It is not always what you think you see, but more importantly, what you do not see that may negatively impact the patient. This case illustrates the need for a radiological specialist to reduce missed diagnoses, misdiagnoses, and medical legal consequences.
Follow-Up Protocol: Further imaging in this case was unnecessary and resulted in wasted expense for the patient and insurance company. A timely consultation with the radiologist can help avoid mistakes and benefit patient care. The radiologist may also streamline care and reduce costs.
History: The films of a 78 year old male with low back pain Films were submitted by a local chiropractor of a 37-year-old female. No history of trauma was reported. The attending scheduled an MRI to evaluate a "tumor" he had noted at the T1 vertebrae. A formal report on the plain film study was requested, "to complete the file".
Findings: Moderate degenerative changes are visualized. Nonspecific calcifications are noted within the left lower quadrant. These densities may represent material within the bowel. More ominous, however, is the suspicious sclerotic lesion noted at the medial aspect of the right ilium.
Discussion: Focal sclerotic densities in patients 40 years and older should be considered blastic until proven otherwise.
