What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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Findings Radiographs demonstrate an opacification of the right upper lobe/upper lung field. MRI demonstrates a large mass of the right upper lung extending into multiple neural foramina and into the spinal canal as well as destroying adjacent bone.
What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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What’s the Diagnosis – Case 166
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Diagnosis: Malignant Neoplasm with Neural Compromise This case is still being worked up so a specific diagnosis has not been reached but this is unfortunately, clearly a malignant neoplasm based on the aforementioned imaging findings. The extension into the neural foramina has caused nerve compression which together with the bony destruction and cord displacement are all in part causing the patient’s symptoms. This case is less about the diagnosis in my mind and more about the systems in place to make sure this type of entity is not missed. I am not casting aspersions or being by any means judgmental about the outside facility. On their study, the mass was not identified. If you go back, their study shows that their lowest axial image does not include the mass which may have contributed to it not being seen. This also highlights the need for vigilant technologists checking cases as they are performed and real time radiologist evaluation of cases when questions arise. If you did not see the findings on the radiographs this also highlights another key system. Clinicians are busy in their practices and often thinking about a certain shall we say silo of entities and rightfully so. Therefore, it would be extremely reasonable to not appreciate the findings on x-ray during a busy clinical practice. This is where it is incumbent upon radiologists to look at the entirety of the study to make sure unexpected findings are not missed. This case nicely highlights how everyone has to work in coordination to try and optimize patient care.
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