Missed Lung Lesions
Missed lung lesions are one of the most frequent causes of malpractice issues. The clinical value of the chest X-ray is uncontested despite recent advances in technology, in particular multi-detector computed tomography (MDCT). The chest X-ray remains the
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15
Nigel Howarth and Denis Tack
Contents
Abstract
15.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
›› Missed lung lesions are one of the most frequent
15.2 Reasons for Missed Lung Lesions . . . . . . . . . . . 372 15.3 Specific Problems . . . . . . . . . . . . . . . . . . . . . . . . 373 15.4 Missed Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . 15.4.1 Nodular Lesions – Tumors . . . . . . . . . . . . . . . . . . 15.4.2 Nodular Lesions – Infections . . . . . . . . . . . . . . . . 15.4.3 Nodular Lesions – Miscellaneous . . . . . . . . . . . . .
373 373 378 379
15.5 Missed Consolidation . . . . . . . . . . . . . . . . . . . . . 381 15.5.1 Airspace Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 381 15.6 Missed Interstitial Lung Disease . . . . . . . . . . . . 384 15.6.1 Diffuse (Interstitial or Mixed Alveolar Interstitial) Lung Disease . . . . . . . . . . . . . . . . . . . . 384 15.7 Take Home Messages . . . . . . . . . . . . . . . . . . . . . . . . 385 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
N. Howarth (*) Institut de radiologie, Clinique des Grangettes - Genève, 7, chemin des Grangettes, 1224 Chêne-Bougeries Geneva, Switzerland e-mail: [email protected] D. Tack Department of Radiology, RHMS Clinique Louis Caty, Rue Louis Caty 136, 7331 Baudour, Belgium
causes of malpractice issues. The clinical value of the chest X-ray is uncontested despite recent advances in technology, in particular multidetector computed tomography (MDCT). The chest X-ray remains the most frequently requested radiologic examination and plays an important role in the detection of and management of patients with chest diseases. The skills for accurate interpretation of the chest X-ray are often lacking due to the pressures required for mastering and making profitable high technology imaging. Missing a lung lesion, especially lung cancer, can carry medico-legal implications. Many methods have been suggested for correct interpretation of the chest X-ray, but there is no preferred or recommended system. A systematic approach that addresses a clinical question is always helpful and being aware of the areas where mistakes are made is essential. By focusing on a side-byside comparison of the chest X-ray and MDCT of common missed lung lesions, this chapter aims to provide an understanding of the reasons certain lesions are missed and help to reduce the busy radiologist’s error rate.
15.1 Introduction Missed lung lesions are one of the most frequent causes of malpractice issues (Berlin 1986, 1995; Potchen and Bisesi 1990). Chest radiography plays an important role in the detection of and management of patients
E.E. Coche et al. (eds.), Comparative Interpretation of CT and Standard Radiography of the Chest, Medical Radiology, DOI: 10.1007/978-3-540-79942-9_15, © Springer-Verlag Berlin Heidelberg 2011
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with lung cancer, chronic airway disease, pneumonia, and interstitial lung disease. Among all diagnostic tes
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