All them youngins’ got swollen heads

We referred a young, generally healthy patient for a CT scan a while ago. I can’t remember what we were investigating, but I do remember that she didn’t have any hard signs of cerebral oedema (brain swelling).

Lo and behold, the radiologist’s report proclaimed, “signs of cerebral oedema.” Uh-oh.

We (students) don’t challenge a radiology report. Most of us have deplorable radiological knowledge. Our consultant certainly didn’t agree though, scanned through the file and concluded that our healthy young patient had a perfectly normal brain as far as the eye could see.

He then explained why he thought the mistake slipped in:

At our hospital, the majority of patients sent for CT Brain Scans are being investigated for strokes, TB Meningitis or Cryptococcal Meningitis. These patients are thus mostly elderly and/or HIV-positive. Incidentally, these two groups commonly display cerebral atrophy. As a result, day in and day out, our radiologists are confronted by diseased, or at the very least atrophied, brains.

This has become their reference point, such that when they see a nice full brain, it appears swollen.

Interesting, no? You still won’t catch me eagerly challenging such a report though – consultants have radiological experience, I do not.

From left to right:
1. Internet Scientific Publications
2. CyberMedicine2000
3. UpToDate

7 Comments

  1. Sam says:

    Radiologists also have crazy monitors that help them see things we don’t… so it would be quite intimidating to challenge their report.

  2. Anna E says:

    That’s interesting!
    And hi, I’m a new visitor here 🙂 5th year med student from Indonesia. You have cool little blog.

    1. It’s great to meet you! I always enjoy getting to know international med students.

  3. charoo iyer says:

    Wow …kinda scary ! Radiologists shouldn’t be making such mistakes

    BTW , just discovered ur blog in the middle of my exams ….and am addicted ! Digging up ur old archives 🙂

    2nd yr med student from India

    1. Thanks for stopping by, nice to meet you! I can understand why they make such mistakes though. It’s just that they get so used to what their average patient’s scans look like…

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