Tuesday, February 13, 2007

Radiology grand rounds IX on Cochinblogs:

10 ways to limit your liability on call, in no particular order: by Mikhail Serebrennik
(quoted from http://www.filmjacket.com/news.php?readmore=54 with permission)
The most important thing is to escape responsibility or at least spread it among as many people as possible, so that you are never solely responsible for a suboptimal outcome. Here are 10 ways to do it.
Disclaimer: Of course, everything in this article is for entertainment purposes only; you should use sound medical judgment, reliable information sources and practice guidelines accepted at your institution at all times, and do everything in the best interest of patient care.
1. Request additional and/or short-term follow-up studies - if you don't know what the heck you are looking at, this may result in someone else having to read the additional/follow-up studies and carry a part of the burden of final decision.
2. Talk to the referring clinician - they may point you in the right direction and even give you the differential diagnosis. Armed with a decent differential, you may be able to produce a reasonable report.
3. Suggest clinical correlation. This is self-explanatory.
4. Call and wake up your attending - it's better to annoy them now than surprise them the next day. If your attending tells you to buzz off and hangs up on you, you've done your part - the responsibility has been spread.
You can read the rest of this piece at: http://www.filmjacket.com/news.php?readmore=54

Dr. Sumer Sethi and Dr. Joe Antony invite case submissions for the next radiology grand rounds IX on cochinblogs. The cases and/ or articles related to radiology will be put on 25th Feb 2007. Anybody interested in radiology including sonography,
conventional radiology, CT scan, MRI etc. may submit their articles, cases etc. to drjoea@gmail.com .

Here is an interesting case.
A 32 yr old comes with history of non specific pain in the knee joint.
Clinically he is normal.
MRI shows a well defined a focal altered signal intensity lesion seen in close proximity to Post cruciate ligament . It is to be differentiated from PCL tear.
Diagnosis: Posterior cruciate ligament ganglion.

Brief description of Posterior cruciate ligament
· Prevents post displacement of tibia on femur
· Extends from med femoral condyle to post and inf to tibial articular surface
· Average length 38 mm and width midpart 13 mm
· Like ACL is intraarticular and extrasynovial
· Vascular supply from middle genicular artery of popliteal vessel
· Ganglion may attach to PCL
· It is differentiated from PCL tear by demonstrating intact underlying PCL and well defined nature of ganglion.
Case presented by Dr. MGK Murthy.

Dont forget to visit our sister site: the free gallery of ultrasound images

Here you'll find loads of interesting sonographic images with a brief description and the best reference links.

A hole in the ….? A case by Dr. G.C. George (http://med97um.net/george/ )

Many have heard of a hole in the heart but for this 58 year old gentleman, it was a totally different story. He was assisted into ER, wailing in pain with every single movement. It was all too sudden. Even taking a deep breath was difficult as the pain was excruciating. He was sweating, his pulse racing, he could barely speak because the slightest effort caused him intense pain.The pain occured suddenly, all over the abdomen causing it to be so “board -like” He could barely move. He requested to be propped up to allow him to breath easily. He never had any such pain before but recently was taking some herbal traditional medication for better health! Yeah sure! My medical officer was called up. A few minutes later, my phone rang and the events were so typical, that I waited eagerly hoping my medical officer would make the correct diagnosis. He sounded a little unsure but at the end of the sentence he blurted out the correct diagnosis. I gave my orders and this gentleman was prepared for surgery. So much for a better health! These are some pictures to help you bloggers complete the title of this article

Case presented by Dr. G.C. George.

The answer: Perforated Gastric ulcer.

The Grand Rounds archive and schedule is available at

and maintained by Dr.Sumer Sethi of Sumer's Radiology Site


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