ESPN 51th Annual Meeting

ESPN 2018


 
IMAGERY MISDIAGNOSE IS BECAUSE OF MALPRACTICE OR? IT CAN BE AVOIDED!
VALBONA STAVILECI 1 IRENA PALLOSHI 1 DIAMANT SHTIZA 1 MERGIME BATUSHA 1 Ilir Ahmetgjekaj 1

1- UNIVERSITY CLINICAL CENTRE OF KOSOVA
2- Qendra Spitalore Universitare Tirane
 
Introduction:

Radiology diagnose errors in our nephrology practice are often found. Children have small size organs, meteorism and examinations are done by technicians and interpreted by radiologist. In the other side rtg equipments are for all ages purpose, this happens in developed countries where don’t have subspecialists-Pediatric radiologis. And the equipments are lately sophisticated with difficult programs, which should be arranged for child size -special module, what don’t happen always, because of a lack of experience and training. Usually there are a lot of artifacts and radiologist than ask for repeated exam. Complications following interventional procedures accounted for 10% of all cases.

Material and methods:

Presentation of three cases: first case after a urosepsis diagnosed with VUR. US concluded hydronephrois but no MCUG. Urine drain all the time was noticed and spinal dimple, so neurologic bladder was suspected. Cystometry findings were contrivers. Than MCUG resulted with no VUR. Pyelography just malrotatio renis dexter. MRurography done with special pelvic protocol finds ureteer ending in vagina, duplex system and megaureter.  Cystoscopy: 1 mm under urethral orificium is ectopic ureter ending. Second case intrauterine hydronephrosis detected. After birth suspected for Ureterocellae. Pyelography findings a double ureteral system infereior urether –megaureter and no ureterocelle. First urotract MR diagnosed upper caliceal hydrinephrosis bladder and rectum can’t be examined. Second MR resulted with one uretheral system.  Cystoscopy findings uretherocelea, ectopic urether and VUR. Third case: 12 months after Theratoma saccrococigealis operation, got urosepsis. US findings Cystic formation around the kidney, asked for CT scan, but happened to be urinoma cause of infection and neurogenic bladder with megaureter. Nuclear medicine errorrs also hapend: DTPA Scintigram errors, on estimating GFR, because it was not calculated between 1-2 min, when is the peak of isotope intake.

Results:

 A lot more invasive unneccesary diagnostic procedures were done. But after a consultations and special meeting separetly with nephrologist, syrgeon and radiologists all three cases ended up with the right diagnose.

Conclusions:

We emphasise that the existence of an error does not always mean the presence of malpractice. Missed abnormalities and misdiagnosis can be avoided if we complete imagery request with clinical information and with joint problem approach with nephrologist, surgeon, radiologist and nuclear medicine specialist.