I would like to start a new section entitled “The wisdom of Dr. Pepe”. I like aphorisms and in this section I would present an aphorism that will summarise the teaching point of the cases presented.
Today I want to show two different cases. Radiographs of Case 1 belong to 86-year-old woman with chest pain. Pulmonary abnormalities are unchanged in comparison with a radiograph taken one year earlier.
Check the images below, leave your thoughts in the comments section. We will publish new images on Wednesday and the answer on Friday!
Click here for the see the images for CASE 1
1. TB granulomas
2. Bronchioalveolar carcinoma
3. Amyloid nodules
4. None of the above
Click here for the answer for CASE 1
Final diagnosis: achalasia (surgically proved) with pulmonary aspiration, possibly atypical TB granulomas (unproven).
Radiographs of Case 2 belong to a 23-year-old woman with cough and low-grade fever.
Click here for the see the images for CASE 2
Showing CT images of the chest. Do they help you?
Click here for the see the more images for CASE2
2. Chronic aspiration
4. None of the above
Click here for the answer for CASE 2
Final diagnosis: tuberculosis of RLL with widespread mediastinal adenopathy.
Congratulations to Olena and MK for their participation and correct diagnosis.
I am showing these cases to emphasize the importance of examining carefully the radiographic images. Aside from having the same etiology (TB), both cases have multiple findings and the sum of all of them are the clue to the right diagnosis.
In satisfaction of search, findings are missed because we don’t search for additional abnormalities after the first one is found. When there are multiple findings, additional ones are discovered less than 50% of the time.
So, once again, try to avoid satisfaction of search. Remember that it accounts for approximately 22% of our errors.
Follow Dr. Pepe’s advice:
Don’t let one abnormal finding keep you from looking for another.
It has been one week since we published the webinar and we would like to send you the pictures we promised. However, we made a big mistake: we didn’t provide for your adding your name and e-mail address to the answers, so I can’t know who’s right and who isn’t.
Since this is our fault, I will honor my word: once you have seen the webinar, you decide if you got three or more correct answers. If so, write a comment on this entry with your name and e-mail address and a dedicated picture of Dr. Pepe will be mailed to you.
Sorry about the inconvenience. I trust your honesty. Scout’s honor.
I’m preparing a cycle of six webinars about basic interpretation of chest radiographs. The first one will be about the PA view, and today I’m presenting six cases that will be shown during this webinar.
You can respond in the blog, as usual. Answers will be given on Monday, November fifth, when the webinar will be posted on the Diploma web.
To encourage your participation, any of you who get three or more right answers will receive a dedicated picture of Dr. Pepe in their mail. Leave your answers in the comments if you want to receive the picture!