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Pitfalls of the Vague Radiology Report

¹ Department of Radiology, Rush North Shore Medical Center, 9600 Gross Point Rd., Skokie, IL 60076, and Rush Medical College, Chicago, IL 60612.

View larger version (94K): [in a new window]   Fig. 1. —Case 1: 68-year-old woman with clinical diagnosis of pancreatitis. Abdominal CT scan was reported by radiologist as showing "nodular appearance of the pancreas...if there is any clinical suspicion of neoplasm, an endoscopic retrograde cholangiopancreatogram may be warranted."

View larger version (150K): [in a new window]   Fig. 2A. —Case 2: 37-year-old asymptomatic man who underwent routine chest radiography. Posteroanterior radiograph shows 1 x 1.5 cm density in right suprahilar region. Radiologist concluded, "It is not clear whether this is due to overlapping shadows, an area of increased density within the rib, or a pulmonary nodule.... a follow-up chest film in 3 to 4 months is recommended to evaluate this finding."

View larger version (141K): [in a new window]   Fig. 2B. —Case 2: 37-year-old asymptomatic man who underwent routine chest radiography. Radiograph obtained 3 months after A. Radiologist reported that nodular density is unchanged and that "correlation with computed tomography of the region may be of value...."

View larger version (154K): [in a new window]   Fig. 2C. —Case 2: 37-year-old asymptomatic man who underwent routine chest radiography. Radiograph obtained 1 year after B reveals extensive carcinoma.

View larger version (142K): [in a new window]   Fig. 3A. —Case 3: 42-year-old man who had undergone treatment for sarcoma of left lower extremity. Posteroanterior (A) and lateral (B) chest radiographic findings were abnormal. Radiologist reported 4-cm density on left, "which in the lateral view appears to lie in the major fissure and is compatible with a pseudotumor." Radiologist suggested comparison with patient's prior films.

View larger version (137K): [in a new window]   Fig. 3B. —Case 3: 42-year-old man who had undergone treatment for sarcoma of left lower extremity. Posteroanterior (A) and lateral (B) chest radiographic findings were abnormal. Radiologist reported 4-cm density on left, "which in the lateral view appears to lie in the major fissure and is compatible with a pseudotumor." Radiologist suggested comparison with patient's prior films.

View larger version (120K): [in a new window]   Fig. 3C. —Case 3: 42-year-old man who had undergone treatment for sarcoma of left lower extremity. Radiographs obtained 6 months after A and B show round 12-cm diameter mass in left lung. Biopsy disclosed recurrent sarcoma.

View larger version (142K): [in a new window]   Fig. 3D. —Case 3: 42-year-old man who had undergone treatment for sarcoma of left lower extremity. Radiographs obtained 6 months after A and B show round 12-cm diameter mass in left lung. Biopsy disclosed recurrent sarcoma.

View larger version (139K): [in a new window]   Fig. 4A. —Case 4: 38-year-old woman who underwent routine chest radiography. Radiologist reported this radiograph as showing soft-tissue density in right chest. Radiologist added, "This could be a scar or even neoplasm. If previous chest x-ray is available for comparison, this would be most helpful."

View larger version (126K): [in a new window]   Fig. 4B. —Case 4: 38-year-old woman who underwent routine chest radiography. Radiograph obtained 22 months after A revealed 4 x 4 cm mass with associated infiltration and hilar involvement. Biopsy disclosed adenocarcinoma.

View larger version (122K): [in a new window]   Fig. 5. —Case 5: chest radiograph of 59-year-old man who underwent routine physical examination. Radiologist reported, "Soft tissue density in right upper lung field which appears to have some calcification within it and may represent a granuloma. However, would suggest an old chest film for comparison." Eighteen months later, patient returned with diffuse metastatic lung cancer.

View larger version (139K): [in a new window]   Fig. 6A. —Case 6: 61-year-old woman who underwent radiographic examination because of abdominal pain. Initial chest radiographic findings reported by radiologist were normal except for "band of atelectasis or infiltrate in the left lung base."

View larger version (141K): [in a new window]   Fig. 6B. —Case 6: 61-year-old woman who underwent radiographic examination because of abdominal pain. Radiograph obtained 1 week after A interpreted by radiologist as "small patchy increased density in left lung base that is stable and probably chronic."

View larger version (128K): [in a new window]   Fig. 6C. —Case 6: 61-year-old woman who underwent radiographic examination because of abdominal pain. Radiograph obtained 7 weeks after B, reported by radiologist as "slight decrease in left lung base density." Ten months later, patient presented with 3-cm carcinoma in left lower lobe.

View larger version (127K): [in a new window]   Fig. 7A. —Case 7: 53-year-old asymptomatic man who underwent routine chest radiography. On Initial radiograph, radiologist reported probable right upper lobe artifact.

View larger version (125K): [in a new window]   Fig. 7B. —Case 7: 53-year-old asymptomatic man who underwent routine chest radiography. Radiograph obtained 2 years after A shows large carcinoma.

View larger version (114K): [in a new window]   Fig. 8. —Case 8: 59-year-old woman who complained of dysphagia and epigastric fullness. Representative radiograph from upper gastrointestinal examination was reported by radiologist as disclosing "irregularity in the cardia of the stomach." Ten months later, endoscopy revealed large infiltrating adenocarcinoma of cardiac portion of stomach.

View larger version (63K): [in a new window]   Fig. 9. —Case 9: 55-year-old man with epigastric discomfort who underwent upper gastrointestinal radiography. Radiologist reported study as showing "gastroesophageal reflux and irregularity of the distal esophageal mucosa compatible with peptic esophagitis and a possible stricture. Reexamination of the esophagus after appropriate medical therapy with either endoscopy or esophagram is recommended." Fourteen months later, endoscopy revealed carcinoma of distal esophagus.

View larger version (121K): [in a new window]   Fig. 10A. —Case 10: 57-year-old woman who underwent screening mammography. Initial mediolateral mammogram was reported by radiologist as disclosing "asymmetrical area of increased density and prominent dysplasia with benign-appearing calcifications...Clinical correlation and follow-up studies are recommended...."

View larger version (109K): [in a new window]   Fig. 10B. —Case 10: 57-year-old woman who underwent screening mammography. Mediolateral mammogram was obtained 8 months after A because patient palpated lump. Mammography now revealed two masses suggestive of malignancy. Biopsy disclosed invasive ductal carcinoma.

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