Off Neuro question
 

I am sorry if I have to throw this off neuro question here, I just don't know who to ask to -- my pulmo and my primary care physician are both on vacation.

I got my recent chest cat scan result but I had to go back to the radiologist to check if there are any indication of abnormality in my diaphragm and if I show any sign of Pectous deformity. The Office Manager of the facility where I had my cat scan came back to me saying that according to the radiologist i have "elevated right hemidiaphragm" and "Pectous deformity". I asked why these findings were not included in my written report and came back to me with this reply: "these are not abnormal findings but anatomic variations thats why i did include in my report".
My question is -- what exactly does it mean by this statement? From a layman's point of view anything that is not in its normal is abnormal. I want to get some inputs before I talk with the radiologist so at least I won't get lost in the discussion. Normally, if I don't have an understanding of the topic, I cannot ask questions and only later on when the discussion is over, when i have some time to research on it, that I think of some questions.

I hope that anybody reading this post who has knowledge of understanding the difference between abnormal findings and anatomic variations would share his/her thoughts about it.

Thank you.

I think you'll have to ask your doctor.

Some variations in anatomy, cause problems. I have one of the GI tract. I have malrotation 90 degrees of my whole GI tract rotated so that my appendix is on the left instead of the right. This was discovered when I had an obstruction in my mid 20's. But when I had the same X-rays in college, they didn't tell me at all I had this! Just gave me antispasmotic pills for the twisting times! So I got into a small bowel obstruction later, and THEN my doctor explained it all to me. Not everyone with malrotation has the symptoms I have...but some of us do.

Mrs.D,
Thank you very much for your reply.
This was exactly what the radiologist said, he did not include it in the report because its not an abnormal findings, its anatomical variations. I am always short of breath. If this radiologist thinks its not worth reporting, his predecessor reported the Pectous deformity when I had an X-ray 2 yrs ago. Isn't it the norm to include in the report whatever is seen in the imaging, including the anatomical variations whether these cause symptoms or not?

I will discuss it with the doctor but you know how some doctors downplay findings that appear harmless but may cause harm down the road.

I think they downplay it for 2 reasons:

1) people are highly suggestible

2) they don't really know what each person is going to experience with the problem.

I found a book about my issues at the U of Mich medical library.
It was 90 pgs long. And it was from Toronto Canada. The gist of it was that some people with malrotation have lifelong problems/symptoms (like me), and others never do. This book had a surgeon's opinion of how to fix some of it. But I have been told by 3 doctors, including one recent radiologist graduate, that my problem is not fixable. So there.

Sometimes there are no answers. :rolleyes:

In my case Mrs. D, the anatomical variations can both cause the symptom of SOB. I read that elevated right hemidiaphragm can either be caused by lung abscess/infection or nerve problems or hepatic dysfunction. I think this variation is important in my diagnosis of MAC and neuropathy. As to Pectous deformity, it may explain some of my SOB.

It may have been okay, if the symptom I am complaining about is not a direct symptom of these variations. I just wish this radiologist could have mentioned them in the result. If at all, nothing can be done about it, at least I know and my pulmo knows about it too so these variations would be in the parameters for consideration in my management. :(

Personally, I think radiologists have a responsibility to report anything they find. It is not their place to determine suggestibility of the patient or whether they will experience symptoms from it. Their job is solely to report the findings (all of them) and leave the clinical diagnosis to the doctor.

It used to be that patients were not reading their own reports. Now patients can be more proactive when they see things like this and start asking more questions.

Hi en bloc,

You expressed the sentiment that I exactly feel about the judgment call made by this radiologist. I could not express better when you said : "their job is solely to report the findings ( all of them) and leave the clinical diagnosis to the doctor". In my limitation of your language, I somehow feel handicapped in expressing my words. That's why when something important like this comes up, I discussed it with my husband and he helps me in discussing my thoughts and ideas with my

Again, thank you. ;)

I find this conversation fascinating. Just recently my primary doctor made an odd comment in middle of discussion of my SFN, about the pineal cyst (in brain) that I have. I have never been told of this, and have had a CT scan of brain twice over last 3 years with this same doctor. She said this time it's roughly the same size as a few years ago, so nothing to worry about. But isn't it odd that nobody ever bothered to even mention it? I do have headaches, ringing in my ears and had some trigeminal nerve issues, no idea if a cyst like this can cause any of that, I did look it up and usually they are asymptomatic and nothing to worry about. Anyway, just wanted to share my agreement with your stories, and hope you get some good focus and answers from your doctor when he/she returns from vacation.

[QUOTE=SFNgirl;980769]I find this conversation fascinating. Just recently my primary doctor made an odd comment in middle of discussion of my SFN, about the pineal cyst (in brain) that I have. I have never been told of this, and have had a CT scan of brain twice over last 3 years with this same doctor. She said this time it's roughly the same size as a few years ago, so nothing to worry about. But isn't it odd that nobody ever bothered to even mention it? I do have headaches, ringing in my ears and had some trigeminal nerve issues, no idea if a cyst like this can cause any of that, I did look it up and usually they are asymptomatic and nothing to worry about. Anyway, just wanted to share my agreement with your stories, and hope you get some good focus and answers from your doctor when he/she returns from vacation.[/

I am upset about it because of seemingly lack of careful evaluations. It was like an after thought to inform me about the findings. I would have never known had I not asked!!!

It is really important that the patients or his/her family representatives be on top of the treatment.

I hope anyone can help me on this concern about wanting to ask the radiologist to make a revised report to reflect the findings in my anatomical variations. I am requesting for something that should have been part of his original report.

To those who are familiar with the Hippa policy, can I invoke a provision of Hippa on my concern? Please note that radiologist has refused to make a revision of his report giving no reason at all.

Thank you in advance for the inputs.

The only thing I can think of is to take the CD of the scan to another radiologist for a second 'reading' and report. I would let them know ahead of time that you want ALL findings reported...specifically the anatomical variations.

Keep in mind though, your insurance will be billed for the reading and you'll incur any copay. This is probably why he won't change the original report...because he won't get paid to do so. It's all about money in the end.:(

I am willing to pay for the co-pay. It's just upsetting why this radiologist refused to make an addendum or revised his report -- I am requesting for something that should have been part of the original report in the first place. Also, if ever I change a pulmo in the future, I want to present an official report and not just show a print copy of an email mentioning about the anatomical variations.... :mad:

Thank you en bloc.

Was this in a hospital setting? or Private?

If it is a hospital setting, I'd report it the administration. Perhaps they don't know what this radiologist is doing?

I agree 100% and understand you being upset. You can try to report him, but I don't know if you will be able to talk with someone 'above' him that can get him to do the job he should have done to begin with.

These guys are in their own world and HATE being wrong...much less, admitting it by changing something they have said or done.

If you can get somewhere with admin, go for it. If it will be a long stressful process that may take a bigger toll on you in the end, then just take it to someone else for a second opinion/reading. I know you shouldn't have to do this, but it may be easier on you in the end.

It's a private facility Mrs.D.

Is it allowed in the forum to say the name of the facility?

I know that my concern is valid. Everything that is seen in the imaging must be reported. It's is precisely this reason why some diseases are discovered accidentally because it is seen in the same image intended for another illness.

Well, you could report him to your state's licensing board.

I think I would report his behavior myself... as you, the patient,
are being ignored. The whole purpose of image testing is to
reveal what is inside you, after all. Not to censor it ---

See if his facility is on one of those doctor evaluation sites, and do your evaluation there. Even Angie's List! (they asked me about MY doctor!)

Alot more people will see your situation on the appropriate venue.

Mrs.D and en bloc,

Thank you both very, very much.

For whatever is worth, I will write one of the owners of the facilty.

en bloc, you are right. It's stressful for me. I am not up to this unnecessary stress in my condition.

Mrs.D, we have subscription on Angie's List, I will see if this facilty has the "comment website".

Again, thanks

One last thought or two.

I think Angie's list, admin, and even the board are all great ideas and I certainly think he needs to be reported. But reporting him doesn't necessarily get you the written report you need. Even if he's put in a position to make good on the job he should have done to begin with, I doubt his report will be as thorough or as well written if he's 'forced' to comply by his admin, etc.

The bottom line is to get you an appropriately worded report that is 'complete' to include all anatomically variations he noted after the fact. Therefore, you may want to consider getting the second reading I suggested so you know it will be objective and complete...and not done with 'attitude' that he's certain to have after being told what to do by admin. Not sure if this makes sense, but hopefully you know what I mean.

Don't let this stress compound your condition. You have 'some' documentation of the variation to provide your doctors. May not be the best or way it should have been done, but it's something.