Blind spots on CT imaging of the head: Insights from 5 years of report addenda at a single institution.

BACKGROUND: Errors of detection ("misses") are the major source of error in radiology. There is sparse prior literature describing patterns of detection error on CT head imaging. PURPOSE: The objective of this study was to gain insight to areas on CT head imaging where radiologists are most likely to miss clinically relevant findings. METHODS: We performed a cross-sectional study of consecutive reports of CT imaging of the head at a single institution spanning 5/1/2013-5/1/2018 (5 years). Detection errors described in addenda were categorized according to anatomic location, type of pathology, and potential impact on management. Blind spots were defined by the most common sites of missed findings. RESULTS: A total of 165,943 reports for CT head imaging were obtained. Addenda were found in 1658 (~1%) of reports, of which 359 (21.7%) described errors of detection. Within the extracranial soft tissues (n = 73) the most common "misses" were at incidentally imaged parotid glands and the frontal scalp. Within osseous structures (n = 149), blind spots included the nasal and occipital bones. Vascular lesions (n = 47) which passed detection were most common at the distal MCA, carotid terminus and sigmoid sinus/jugular bulb. No predisposition was seen for anatomic subsites within the CSF space (n = 60) and brain parenchyma (n = 65). CONCLUSIONS: Consistent patterns of blind spots are revealed. Radiologic teaching and search patterns to account for these sites of error may accelerate trainee competence and improve accuracy in the practice of radiology.

Symmetric, bilateral upper and lower extremity lucent lesions in a patient with Gaucher's disease on enzyme replacement therapy.

We report a case of a 6-year old girl with known type 3 Gaucher's Disease on enzyme replacement therapy who developed bilateral, symmetric osteolytic lesions in her humeri and femurs. While this manifestation of Gaucher's disease has been previously documented, it is an exceedingly rare variation. We observe that this patient shares 2 commonalities with 3 other patients reported in the literature to present with this phenotype. First, the patient's L444P/L444P genotype, present in approximately 11% of all Gaucher's patients, was also seen in these other patients. Second, like the other patients, this patient was treated with enzyme replacement therapy. It is unknown whether there is a correlation between these 2 independent variables and this rare phenotype, and further investigation may be warranted.

Radiographic Manifestations of Diffuse Pulmonary Alveolar Derecruitment.

Pulmonary alveolar derecruitment is a process of alveolar collapse that occurs in critically ill patients. While the entity and its physiological manifestations are described in the anesthesiology and critical care literature, the radiographic manifestations of alveolar derecruitment have not yet been thoroughly described. This phenomenon can have a similar appearance to pulmonary edema; however, patients often have severe intravascular volume depletion. As the treatment for these 2 entities is essentially contradictory, it is important to be familiar with alveolar derecruitment and consider it as a differential diagnosis when clinically appropriate.

If You Twinkle When You Tinkle, Stones Are Found on Ultrasound.

Urolithiasis in children is an underrecognized cause of pediatric abdominal pain. Our case describes a child who presented to the emergency department with right lower quadrant pain, in whom a point-of-care ultrasound detected an ureterovesicular stone, which obviated the need for any further radiographic studies. We review the current literature on pediatric urolithiasis with a focus on sonographic diagnosis.