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Chairman's Corner
Chairman's Corner
Interesting cases ..... or ?
Interesting cases ..... or ?
Ravi Ramakantan
Ravi Ramakantan
On a 'routine' afternoon, I was at a reporting session when I came across the chest film of a young lady - newly detected to have diabetes, who had been referred by our endocrinologist.
On a 'routine' afternoon, I was at a reporting session when I came across the chest film of a young lady - newly detected to have diabetes, who had been referred by our endocrinologist.
Usually newly detected diabetics have a routine chest film done to rule out pulmonary tuberculosis. This young patient could have been a juvenile diabetic and I was about to call the chest film as - ' normal '. Just as I was about to close this study and move on, I saw vague calcific shadows in the left upper quadrant of the abdomen near a gas filled splenic flexure.
Usually newly detected diabetics have a routine chest film done to rule out pulmonary tuberculosis. This young patient could have been a juvenile diabetic and I was about to call the chest film as - ' normal '. Just as I was about to close this study and move on, I saw vague calcific shadows in the left upper quadrant of the abdomen near a gas filled splenic flexure.
I put two and two together and concluded that this could be pancreatic calcification and quickly windowed and lo and behold, - there were ‘beautiful small circular calcifications in the head and especially the tail of the pancreas.
I put two and two together and concluded that this could be pancreatic calcification and quickly windowed and lo and behold, - there were ‘beautiful small circular calcifications in the head and especially the tail of the pancreas.
It looked like a work of art.
It looked like a work of art.
Suddenly a routine reporting session turned into a ‘wow’ moment in an art gallery!
Suddenly a routine reporting session turned into a ‘wow’ moment in an art gallery!
I called out to my colleague sitting at the nearby reporting console and, together we discussed the vicious details of the disease that are hidden in such beautiful images. We talked about the spoked wheel arrangement in an oncocytoma, the floating lilies of hydatids or the choroid blush in a dural AVF.
I called out to my colleague sitting at the nearby reporting console and, together we discussed the vicious details of the disease that are hidden in such beautiful images. We talked about the spoked wheel arrangement in an oncocytoma, the floating lilies of hydatids or the choroid blush in a dural AVF.
For a few years in the 1990s, radiologic images that appear to show up as common day to day living things used to be published in the journal Radiology as 'interludes’. Looking back, I now feel, such use of patient images was inappropriate.
For a few years in the 1990s, radiologic images that appear to show up as common day to day living things used to be published in the journal Radiology as 'interludes’. Looking back, I now feel, such use of patient images was inappropriate.
Here is why.
Here is why.
We cannot deny that we often go to town admiring how ‘lovely or interesting or great’ these ‘cases’ are .. not thinking simultaneously - of the disease burden that such ‘Wow! what a beautiful case' bring along with them.
We cannot deny that we often go to town admiring how ‘lovely or interesting or great’ these ‘cases’ are .. not thinking simultaneously - of the disease burden that such ‘Wow! what a beautiful case' bring along with them.
This is not to say that we are not aware of the patient; but often, the 'beauty' in the images seems to hide the agony that lies hidden beneath it.
This is not to say that we are not aware of the patient; but often, the 'beauty' in the images seems to hide the agony that lies hidden beneath it.
As teachers, it it important we behave with circumspection when viewing these images even when out of the earshot of patients. Students are always watching and they learn by example. We should be aware of the need for sobriety especially when seeing or discussing such images in front of patients that these images belong to.
As teachers, it it important we behave with circumspection when viewing these images even when out of the earshot of patients. Students are always watching and they learn by example. We should be aware of the need for sobriety especially when seeing or discussing such images in front of patients that these images belong to.
‘Wowing’ ‘beautiful’ images unaware of patients and relatives standing nearby or discussing patient details in common elevators are issues that we need to be sensitive about.
‘Wowing’ ‘beautiful’ images unaware of patients and relatives standing nearby or discussing patient details in common elevators are issues that we need to be sensitive about.
As radiologists, we will often see beautiful images that make interesting cases...
As radiologists, we will often see beautiful images that make interesting cases...
But these days, each such time, I ask myself:
But these days, each such time, I ask myself:
Are these
Are these
Interesting cases or Unfortunate patients?
Interesting cases or Unfortunate patients?
I hope,
I hope,
Soon... you will too!
Soon... you will too!
April 2019
April 2019
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