Standard non con stone abdomen pelvis on elderly patient coming from icu to med surg and heart was super big, but on non reconstructed axials thought I saw two different densities above the diaphragm. In hindsight probably LV vs. RV. Bit it’s confusing since it’s so large and abnormal. Of course I’m not scanning but training someone and let them know I think this is stomach and we need to scan at least through the stomach and repeat upper abdomen to include “stomach”.
Of course day has been busy and it’s late afternoon and I’m a little fatigued and the phone probably rang like five times (probably three) during this scan and with two delayed outpatients that got bumped by our inpatients waiting so of course multi tasking away like mad and yet behind behind behind schedule. What else is new? That phone. That phone. Man I hate that thing.
Twenty minutes later scanning one of our outpatients and radiologist calls and asks what are the stomach views. I let him know that I thought I saw stomach above diaphragm and wanted to include all abdomen anatomy on abdomen pelvis ct and thought if the patient had a hiatal hernia I ought to include the stomach. Hiatal hernia? The guy actually laughs at me and says you ought to leave being a doctor to the doctor and at this point I am just deflating while taking this call and scanning another patient.
So at some point catch a moment and check my scans, check the patients priors, cxr’s etc... So, finally can look at the reconstructed coronals and see that this was all clearly heart tissue not stomach. Go to said rads office and mumble something about thinking I saw something but on non reconstructed, hence grainy axials and running with it. Apologizing and letting him know that after looking at the recons I can clearly see that it was heart and not stomach. And thanking him for bringing it to my attention. He mentions somewhat tongue in cheek that at least the patient was older if I’m going to scan again and RE-radiate.
Man. I hate, hate, hate this kind of thing. Still thinking about it the next day. Now I know, next time check those reconstructed coronal images prior to RE-scanning. What I’m kicking myself for is two fold. 1. Missing the anatomy, and 2. Not checking multiple times that what I thought I saw was what was actually the case. What sucks and sometimes it is invigorating and fun, is that the department goes all day sometimes at a million miles per hour and sometimes you just need to scan as fast as you can for hours on end. It gets crazy. And it gets fatiguing and disorienting. Add someone trying to learn from you and asking all sorts of questions while you’re just trying to survive the day and well, if you do CT you probably know. And I have been doing ct for 16 yrs. and doing radiography for more than twenty. I didn’t just arrive on the scene you know. Still, hate it when something goes awry. That’s definitely not the normal course of things.
Just thought I’d share. Was on my mind.
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source https://www.reddit.com/r/Radiology/comments/htvl5v/tifu_ct_thread_thought_heart_was_stomach/
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