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 thoughts on “All them youngins’ got swollen heads”

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

  2. 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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