There are some things which cannot be learned quickly, and time, which is all we have, must be paid heavily for their acquiring. They are the simplest things; and, because it takes a man’s life to know them, the little new that each man gets from life is very costly and the only heritage he has to leave
Dear friends, this quote from Ernest Hemingway serves as introduction to the next series of webinars. From October to March I intend to give a webinar every two weeks describing my basic approach to interpreting the chest radiograph. The subject is ample, and will continue with a second series in 2021.
To start, I am showing a preoperative PA chest radiograph for varices in a 60-year-old woman. The chest was read as normal, but there is an abnormality, difficult to detect.
Do you see it?
The answer was given during a webinar. You can watch the webinar here
Click here to see the answer
Findings: PA radiograph shows a small nodule overlapping the left cardiac border (A-B, arrows). The nodule was overlooked, and the chest was read as normal.
A chest radiograph taken four years later shows a marked increase in size of the nodule (C, arrow). Enhanced axial CT shows a non-enhancing low-density nodule (-30 H.U.)
(D, arrow). Needle biopsy confirmed the diagnosis of hamartoma.
Final diagnosis: Pulmonary hamartoma, overlooked in the initial film
Congratulations to Uve, who discovered the nodule with a little help.
Teaching point: Remember that overlooking visible findings accounts for 50% of our errors. Using checklists is an excellent way to change an error into a discovery.