When the diagnosis is like a thread of spider web

A 70-year-old-man with a diagnosis of stage IV non-Hodgkin lymphoma spreading to the liver and the gastric area started with mild abdominal discomfort a week after chemotherapy . He had no fever or vomiting. Physical examination detected pain and abdominal tenderness. A thoracic X-ray evaluated by a radiologist was the key for a correct diagnosis……

FINAL DIAGNOSIS: SMALL BOWEL PERFORATION. INTRAABDOMINAL GAS (right diaphragm area).

COMMENTS: Radiologist are able to detect changes in a plain X-ray that could be missed for another specialist. When this happens an organizational or systemic compound is on the base of the diagnostic error.

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