RESUMO
Radiological diagnostic errors are common and may have severe consequences. Understanding these errors and their possible causes is crucial for optimising patient care and improving radiological training. Recent postmortem studies using an animal model highlighted the difficulties associated with accurate fracture diagnosis using radiological imaging. The present study aimed to highlight the fact that certain fractures are easily missed on CT scans in a clinical setting and that caution is advised. A few such cases were discussed to raise the level of suspicion to prevent similar diagnostic errors in future cases. Records of adult patients from the radiological department at an academic hospital in South Africa were retrospectively reviewed. Case studies were selected by identifying records of patients between January and June 2021 where traumatic fractures were missed during initial imaging interpretation but later detected during secondary analysis or on follow-up scans. Seven cases were identified, and the possible causes of the diagnostic errors were evaluated by reviewing the history of each case, level of experience of each reporting radiologist, scan quality and time of day that initial imaging interpretation of each scan was performed. The causes were multifactorial, potentially including a lack of experience, fatigue, heavy workloads or inadequate training of the initial reporting radiologist. Identifying these causes, openly discussing them and providing additional training for radiologists may aid in reducing these errors. Contribution: This article aimed to use case examples of missed injuries on CT scanning of patients in a South African emergency trauma setting in order to highlight and provide insight into common errors in scan interpretation, their causes and possible means of mitigating them.
RESUMO
Chest wall or pleural-based tumours represent a heterogeneous group of lesions that are infrequent in children and infants; however, a large proportion of these lesions are malignant in nature. Categorising them on the basis of primary versus secondary, site of origin (osseous and cartilage, or soft tissue) and tissue composition may assist in narrowing the differential diagnosis. We present a case of a 7-year-old boy with a progressive history of dyspnoea. The initial chest radiograph (CXR) demonstrated complete opacification of the left hemithorax with no air bronchograms. This was associated with the cut-off of the left main bronchus and mediastinal shift to the right. The post-contrast computed tomography (CT) of the chest showed multiple left-sided enhancing pleural-based masses with collapse of the left lung. These lesions were locally invasive as demonstrated by the intra and extra-thoracic extension. There were no associated erosions of the adjacent ribs or intra-tumoural calcifications. Based on the imaging findings, the diagnosis of extra-skeletal Ewing sarcoma (ES-EWS) of the chest wall was made with a differential diagnosis of rhabdomyosarcoma. A core biopsy was performed of the pleural-based mass, and histology with immunohistochemistry confirmed the diagnosis of a malignant small round blue cell tumour; subtype Ewing sarcoma family tumour (ESFT). The child was subsequently commenced on chemotherapy. The diagnosis of ES-EWS should be considered when a child or adolescent presents with an ill-defined, eccentric, chest wall mass in the absence of a lesion with a primary osseous origin. Imaging plays a key role in tumour staging, therapeutic planning and follow-up of patients.
