A few days ago I was comparing notes with a colleague, and we both related unexpected findings from tests, findings which significantly altered the course of treatment for these two patients.
Serendipity came to mind as a description: serendipity \sehr-uhn-DIP-uh-tee\, noun:
The faculty or phenomenon of making fortunate accidental discoveries.
Luck also came to mind: luck n.
The chance happening of fortunate or adverse events; fortune: They met one day out of pure luck.
Good fortune or prosperity; success: We wish you luck.
One’s personal fate or lot: It was just my luck to win a trip I couldn’t take.
I suppose the biggest difference is that you cannot have bad serendipity.
My case was a fellow with a hernia I was CTing and found renal cell CA, a potentially curable problem that usually goes undiagnosed until it’s too late. My colleagues’ case was a fellow with a femur fracture from being thrown off a bull. Absoultely benign abdominal exam. The EP’s quote was “I wimped out” and ordered a CT, which found a subcapsular splenic hematoma (bleeding around the spleen, but inside its protective capsule – at least for a while).
This stuff makes me want to just CT people at triage.
edited for spelling
“potnetially” curable problem – what medical school is this from?
From the Spelling Nazi’s sister
Oh- and good save for both guys!
From the schol where they told us we had a lot of potnetial.
hehe.
Fixed.
Wonder if CTs will ever become part of a standard annual physical exam? Probably depends on the insurance companies. Are there any side effects?
Interesting story about the renal cell ca. I’ve had two cases I lucked into. The first one was a guy in his 40’s with back pain unresponsive to conservative managment, so I ordered an MRI. The radiologist happened to get a look at his kidney which showed a mass. He’s 3 years out, considered cured.
The second was a lady in an MVA whose EP “wimped out” (I don’t think so) and ordered a CT on her belly and found another RCC. She’s 2 years out and considered cured.
Routine use of CT in annual exams would result in a significant rise in cancer incidence. An abdominal CT gives you a 10 mSv effective radiation dose. Head CT 2 mSv and chest 8 mSv. 10 mSv equals 3 years worth of natural background radiation, and raises the lifetime additional risk of cancer by 1:10000-1:1000. The effect is cumulative. This means that every time you are CT scanned, the cancer probability of cancer gets higher. Routine annual CT would cause tens of thousands of cancer cases in the US.