Author Archives: Ppotok

Suspect varicocele

imageSuspect varicocele left side.

without Valsalvaimage

with Valsalvaimage

Saying “suspect varicocele” would cause uncertainty for the report reader. A consultant would have no choice but to request images to decide if there is or isn’t a varicocele.

Unnecessary hedges like this devalue radiologists. Why pay a radiologist when the urologist will look at the same images and say “there is a varicocele”?

Rewrite: Left sided varicocele.

 

atelectatic change

Turning the noun atelectasis into the adjective “atelectatic” results in use of two words instead of one.
“Atelectatic change” says nothing more useful than “atelectasis”. 
If it’s a description that’s needed then “subsegmental opacity with volume loss” etc. is a better description of atelectasis. “Atelectatic change” isn’t a description.

poor effort

“Enlarged cardiac silhouette may be secondary to the patient’s poor respiratory effort as well as portable AP technique.”

Respiration is the act of breathing and includes both inspiration and expiration. It would be better to say “inspiratory effort.”  However, it’s not possible to judge a patient’s effort by radiography. It could be the patient was in pain and made a great, albeit unsuccessful, effort. 

 I’d say “Enlarged cardiac silhouette accenuated by hypoinflation.”

on the left

“Abutting the submandibular gland on the left.”

Say “Abutting the left submandibular gland” It’s shorter and unambiguous. The example sentence could conceivably mean abutting the left side of either submandibular gland.

again noted to be

“There is again noted to be stable persistent symmetric increased activity throughout the thyroid bed.”


“There is again noted to be” – delete

“stable persistent” – if something is stable it HAS to be persistent; just say stable
“throughout the thyroid bed” – presumably this means the thyroid gland. But open to interpretation
rewritten version: “Stable, diffusely hypermetabolic thyroid gland.”

at the present time

“At the present time there is no evidence of pulmonary embolus.


I have no idea how saying “At the present time” is supposed to benefit the clinician more than just “No evidence of pulmonary embolus.”

The word “evidence” is overused and most often incorrectly, but I’d let it go in this instance. Although we usually see emboli, it’s conceivable we could infer their presence based on classic evidence such as pulmonary infarct, oligemia or right heart strain.
I say “No embolic lung disase” but I think “No evidence of pulmonary embolus” is okay.

radiographically evident

“No radiographically evident cardiopulmonary disease.”


I don’t believe it’s possible to diagnose something on a radiograph that has no radiographically evident findings. No do I believe we can be reasonably held to the standard of seeing something that cannot be seen. 
It’s doubtful this wording would be an effective medicolegal hedge. If you say “not radiographically evident”, but 100 other people see a pulmonary nodule, then it is radiographically evident regardless of your statement to the contrary. Would be in no worse a defense position saying “No cardiopulmonary disease”  or “Normal study” and missing the same nodule.

new cholecystectomy

“Cholecystectomy appearing since the prior exam.” 


Cholecystectomy is a procedure. It doesn’t just appear, a surgeon performs it. Better said something like “Cholecystectomy since the prior exam” or just “Interval cholecystectomy”.
A complete sentence would be “There has been an interval cholecystectomy” but I think just the two words “interval cholecystectomy” is better. They can’t mean anything other than “Since a prior point in time the gallbladder has been surgically removed.” If the date of the prior exam has been specified in the report, that unambiguously establishes the starting point of the interval.
Interval is often used incorrectly as in “Interval cholecystectomy since the June 12, 2010 exam”. This is redundant use since omitting “interval”  doesn’t change the meaning: “Cholecystectomy since the June 12, 2010 exam.” 

a granuloma

“A calcified 5 x 4 mm nodular density is seen in the left mid lung again unchanged, consistent with prior granulomatous disease.”

Another example of calling Aunt Minnie a “seventy-ish Caucasian female about 5 foot 2 inches with glasses and a cane.”

Say something like “5 mm left mid lung granuloma” to ease the reader’s task.