ACR Bulletin Feature Article

 

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Case of the Year

One case stood out in a sea of 261 submissions.case in point

In medicine, a diagnosis is not always straightforward. Many diseases or conditions can present in various way, depending on the circumstances. So how do you train for the uncommon presentations?

 

Case in PointTM (caseinpoint.acr.org) allows radiologists to evaluate common findings as well as diseases and conditions that can present in interesting ways. The 2016 Case in Point Case of the Year, isolated neurosarcoidosis, is an example of the latter.

"Neurosarcoidosis is not uncommon but is a great mimic," says Vikas Jain, MD, assistant professor of radiology at MetroHealth Medical Center in Cleveland, Ohio, and co-author of the case. "Our case was a very unusual presentation of a common disease."

Throughout the year, ACR staff gathered data from reader surveys to determine Case of the Month winners. The Case of the Year is pulled from those 12 cases and ultimately determined by Case in Point associate editors. "This is always challenging because we have so many great cases," says Kitt Shaffer, MD, CIP editor-in-chief and program chair. "It was a very close race this year."

Many Case in Point cases are examples of residents working closely with their mentors and attendings in a traditional fashion — case in point in textresidents provide their assessment and send it on to their attending to look over later. In some instances, it's kismet. "As residents, we try to look at cases on our own, formulate an opinion of the case, and then go over our findings with the attending, but sometimes we're both at the PACS station, and the study just pops up, so we go over it together," says Hollie Gallagher-Zate, DO, the case's resident co-author, also at MetroHealth.

But it's not all about the clinical information. The Case of the Year winner is also selected based on the quality of the writing and the educational value provided.

"This was the first time I had written up a case," says Gallagher-Zate. "The toughest part was the literature search, which consisted of compiling the different sources and determining which were of value, used appropriate research methods, and pertinent. There's a lot of literature on sarcoidosis, but when you start looking for neurosarcoidosis and then isolated neurosarcoidosis, that literature pool gets smaller and smaller. This was definitely the most challenging part of writing up the case," she adds.

Unlike his co-author, Jain has some experience working with Case in Point cases. "I've worked with other residents to submit four or five other cases," he says. "It's a great educational tool, and I encourage my residents to review cases."

Check out the case (bit.ly/CaseoftheYear) and then read on to learn more about the Case of the Year and its authors in this Q&A with Gallagher-Zate.

Why did you select this case for submission?

It beautifully depicted a rare and interesting case of isolated neurosarcoidosis from initial presentation to biopsy and treatment response.

What did you learn from working on the case?

I learned about the various ways neurosarcoidosis can present as well as how difficult testing for it can be (unlike the simple blood test obtained in systemic sarcoidosis). Additionally, submitting this case helped me get a feel for publishing case and presentations.

How did guidance from senior staff at your institution impact your learning and case development?

My attending greatly impacted both my education of the topic as well as the process of submitting the case, from acquiring the images to the layout of the graphics and difficulty level of the questions.

Why did you choose Case in Point for submission of your case?

People visit Case in Point every day because it only takes a short amount of time to learn a great deal of information spanning all aspects of radiology. The image quality is top-notch and the quiz questions are a fun way to learn and take a little break from the day. I wanted to be among those cases and it was an honor to be selected.

Congratulations to all case contributors. The College could not maintain such a high level of quality without a steady supply of incredible cases.


 

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