Re: Misleading Imaging exams
From: art fougner, md (evsono@pipeline.com)
Fri Jan 9 09:52:27 2004
Myer -
one lab in our area has a habit of recommending sono if something seen
on CT or MRI and CT or MRI if something seen on sono. Makes you wonder
about their motivation.
art
At Fri, 9 Jan 2004, Myer Bornstein wrote:
>
>I just received an ultrasound that showed a complex mass in a 60-year-old
>patient. The radiologist recommended a CAT scan or MRI to look at the
>mass better. I find radiologist always say do a imagining test to prove
>out what the saw with an other test. I make my decisions on what to do
>rather on clinical grounds first.
>Myer
>
>--
>Myer S. Bornstein, MD, MMM, FACOG, FACPE, CPE
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Braun, R.
>Daniel
>Sent: Friday, January 09, 2004 11:17 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Misleading Imaging exams
>
>Agreed. The problem I have is with imaging procedures that come up with
>a diagnosis of benign ovarain cyst and then my residents "Believe" that
>that is as good as a biopsy.
>
>Dan
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
>fougner, md
>Sent: Friday, January 09, 2004 8:17 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Misleading Imaging exams
>
>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
>
--
art fougner, md
ich bin ein New Yorker
