Clinical reasoning and the Emperor new clothes: the problem with perception in Radiology

You look, but you don’t see

Vision is an automatic act, it keeps us aware of our environment to react before a danger or an opportunity. When we want to get more information, we concentrate our minds and our eyes over an object or situation, in a more conscious and active way.  After analyzing an

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Low-molecular-weight-heparin : it is not so easy as you could think

Introduction

This is the case of a -62-year-old woman  with a diagnosis of gynecologic cancer and a pulmonary embolus. She was  receiving chemotherapy and a therapeutic dose of a low-molecular-weight-heparin (LMWH) . She had a single daily dose of a 1,5 mg/per Kilo, calculated in base on her body weight.

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Looking for an answer: Gastric and small bowel dilatation

Clinical summary

The patient

Age: 77         Gender: Male

History of diseases: 1. Diabetes (several years with insulin)

2. Bladder cancer, regional, treated with chemotherapy nine months before this event, considered  complete response

Current problem: deterioration with renal insufficiency, deep venous thrombosis in his left leg with lymph nodes in the left groin, probably associated with a recurrence of the urological cancer. Episode of acute thoracic pain without coronary artery involvement. No fever. No shortness of breath. No abdominal pain. A week before, the patient started with some nausea and vomiting, but he had an active life.

Clinical evolution: improvement in kidney function after hydration.  Blood pressure going down without fever. Hemoglobin very down (Hb=6,5), needs a transfusion.  No sign of external or internal bleeding. Upper endoscopy: no ulcers, no tumor.

Finding without explanation: gastric and small bowel dilatation, without a visible mechanical obstruction or a lump.

We thought about diabetic gastroparesis, small bowel or peritoneal metastases or an abdominal ischemic problem.

Send your opinion. Thank you

Author: Lorenzo Alonso, MD.

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“Blindness” to another problem during the COVID-19 pandemic: a clinical case

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Clinical summary

A 76-year-old woman had a diagnosis of metastatic colon cancer. After surgery and  chemotherapy, there was only a solitary metastasis  in her right hepatic lobe, close to the capsule. The oncologist decided to treat this metastasis  with radiofrequency. Continue reading “Blindness” to another problem during the COVID-19 pandemic: a clinical case

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