Re: Misleading Imaging exams
From: Joanne Bulley, MD (islesannie@yahoo.com)
Fri Jan 9 08:44:34 2004
I agree with both of you, Dan and Art. Gotta look at the patient -
listen to her and remember the differential diagnosis list.
I was a bit amazed at the pelvic abscess found at laparotomy - but she
tolerated the TV US and pelvic exams etc - no peritoneal signs either.
Joanne
At Fri, 9 Jan 2004, art fougner, md wrote:
>
>No test has a 100% predictive value - imaging may give misleading
>results - no argument - but how often does a pelvic exam fail to reveal
>pathology? Padilla et al, publishing in Obstetrics and Gynecology, Oct
>2000 described a less than 40% sensitivity for the detection of adnexal
>masses during a bimanual exam UNDER ANESTHESIA. ultimately, one needs
>to remember Ben Kenobi's dictum, "Trust your instincts."
>
>At Fri, 9 Jan 2004, Braun, R. Daniel wrote:
>>
>>Speaking of misleading imagining exams ...
>>
>>Exactly. I have to keep reminding our residents that imaging studies
>>are helpful in showing that something is wrong in the pelvis, but not
>>necessarily very good at telling us what it is. I don't know how many
>>ovaries have really turned out to be fibroids and vice versa over the
>>years.
>>
>>Dan
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>>Bulley, MD
>>Sent: Friday, January 09, 2004 1:04 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Misleading Imaging exams
>>
>>Speaking of misleading imagining exams ...
>>
>>Recent case of woman with a Pelvic US (including transvag) and a CAT
>>scan - read as fibroid uterus and small ovarian cysts. several month
>>history of pelvic pain. Abdominal exams and pelvic exams by more than
>>one doctor (including primary doc and ObGyn) and second opinion with me
>>and ER visit as well.
>>
>>No signs of acute abd etc.
>>
>>Went to surgery for presumed fibroids with torsion or necrosis.
>>
>>Findings:
>>Major pelvic abscess - everything socked in the pelvis. No significant
>>fibroids.
>>
>>Walled off so well - that she doesn't recall the vaginal probe US and
>>being a problem!
>>
>>JEB
>>
>>--
>>Joanne Bulley, MD
>>Keene, NH, USA
>>
>>-----
>>Work to create peace everywhere you go and with everything you do.
>>-----
>>Let us accept truth, even when it surprises us and alters our views.
>>-George Sand
>>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
Joanne Bulley, MD
Keene, NH, USA
-----
Work to create peace everywhere you go and with everything you do.
-----
Let us accept truth, even when it surprises us and alters our views.
-George Sand
|
|
