April Case of the Month
Authors: Amanda Jeanne Beer, MD,PGY-5, Resident, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, and Luke Lancaster, MD, Associate Professor, Nuclear Medicine and Pediatric Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
Why did you select this case for submission?
I selected the case because it was a good learning case for both radiologists and technologists to continue to search for the source of the abnormality on a diagnostic exam.
What should readers learn from this case?
Readers should learn from this case that, when it comes to the vascular system, one should always search upstream from the abnormal waveform to find the answer. In this setting, we followed the renal artery proximal to the abdominal aorta, the upper extremity vessels, and more proximally to the descending thoracic aorta.
What did you learn from working on the case?
I learned from this case to always be on the lookout for "zebras," even on screening exams. This exam was performed for hypertension in a pediatric patient, and the diagnosis was a surprise to everyone!
How did guidance from senior staff at your institution impact your learning and case development?
Guidance from Dr. Lancaster was key as he was just as enthusiastic about the case as I was. He is also the physician who recommended evaluating both upper extremity arteries once we found that the abdominal aorta had an abnormal waveform.
Why did you choose Case in Point for submission of your case?
I chose CiP because I like the simple, brief, high-yield format more than other daily cases available online.
What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?
Online learning is much more appealing as it is mobile, quick, and up-to-date. I will continue online learning in my practice far more so than other avenues of continuing medical education.
Are you a regular reader of Case in Point? What are your favorite types of cases?
Yes, I'm a regular reader of CiP. I have professional interests in pediatrics and breast imaging. Would love more nuclear medicine cases if those are available!
Is there anything else you'd like readers to know about your case?
I would like to share that having a good relationship with a good radiologic technologist is the backbone of being a good radiologist. Our technologist noticed the abnormal waveform in the renal artery and then obtained Doppler waveforms in the aorta. She spoke with Dr. Lancaster at the time of the exam, who recommended evaluating the bilateral upper extremity arteries after that. This critical relationship of mutual respect and teamwork maximizes patient care and outcomes, as can be seen in this case.