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"ground glass" diagnosisFrom: JT & JL Tomko (buddy@redrose.net)Fri Dec 12 11:36:17 1997
Without going in to the politics of this query.... A local OB/gyn does TV only scans of patients. Training to date a few ultrasound courses. A patient of ours went to seek a second opinion of a complex cyst we were following. Our scans showed complex ovarian cysts with internal debris...alternate dx of endometriosis versus hemorrhagic cyst. Our doc decided to be cautious and placed patient on a two month cycle of oc's. On our follow-up scans (6 week intervals) the prior cyst was gone with the other ovary showing a complex cyst. Patients symptoms of dyspareunia and dysmenorrhea had subsided with the oc use. The kicker....in front of our doc's collegues the second opinion doc lambblasted her for not seeing the 'ground glass' appearance. To date I really only remember one article describing this and our rads also felt diagnosing a pathologic condition was just not something they wanted to open themselves up to. Also I have encountered that 'ground glass' appearance on myself following extensive laser surgery I had post op internal bleeding that walled itself off...I tried to explain this to the doc...ground glass is a sonographic appearance and NOT conclusive to endometriosis. So the question is: (Dr. Worrell please offer opinion also) Do your centers as a routine make a pathologic diagnosis? My personal thoughts are: 1. The second opinion doc really has only her/himself to answer to for his patient care. So if he/she says this is endometriosis....takes a laproscopic peek...finds some implants in the cul-de-sac and the cyst was a hemorrhagic corpus leuteal cyst...will he go the long run and tell the patient.. Hmm you have endometriosis but that cyst we saw was a hemorrhagic cyst...or does he/she say...you have endometriosis and my ultrasound diagnosis was on the money? 2. How much shorter is the rope to hang ourselves by a pathologic diagnosis? Thanks for any thoughts you could add to this dilemma. I am holding off talking to the radiologists at this time. Our doc wants our reports to be more conclusive and I just think that could be some very bad medicine. Janet Tomko RDMS
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