Allegation:
Misinterpretation of an imaging study resulted in several unnecessary surgeries, leading to additional complications.
The Case:
The patient, a 54 YOWM (5’10”, 204 lbs.) with a history of abdominal bloating presented for an ultrasound. The ultrasound technician documented the gallbladder was hard to visualize. The patient reported no surgical history of cholecystectomy and he was NPO at the time. The defendant radiologist read the ultrasound and stated in the body of the report that the gallbladder was not visualized. He went on to document the impression that the echogenic area seen probably represented a contracted gallbladder filled with stones; however, no lumen was demonstrated. The common bile ducts and intrahepatic ducts were not dilated.
As a follow-up, a HIDA scan was obtained the next month; a different radiologist read the scan. His impression of the scan was a non-visualization of the gallbladder compatible with cystic duct obstruction, and concern for cholecystitis, whether chronic or acute. A patent common bile duct was identified.
A general surgeon saw the patient; the patient continued to present with RUQ abdominal pain, bloating, and distention. The surgeon documented a history of asthma, hiatal hernia with repair, and stomach or duodenal ulcer. The patient’s medications included AndroGel®, triamcinolone cream, TREXIMET®, and albuterol. On exam, the abdomen was non-tender to palpation. An upper endoscopy showed gastritis, but the patient’s symptoms did not improve with proton pump inhibitors. The surgeon’s assessment was cholecystitis and cholelithiasis.
Several weeks after the original ultrasound, the patient saw a gastroenterologist, who documented that the endoscopy revealed a polyp and moderate esophagitis. The patient was also positive for Barrett’s esophagus with goblet cells.
About three weeks later, the patient underwent a diagnostic laparoscopy with intraoperative cholangiogram. The surgeon took down considerable adhesions. The areas of the gallbladder fossa and porta hepatis were difficult to visualize because of apparent chronic inflammation with adhesions. Because the surgeon never visualized a gallbladder, he decided to perform an open cholecystectomy. While the surgeon visualized the common bile duct, there was no cystic duct or gallbladder seen. The patient had no palpable gallstones. Rather than a contracted gallbladder with stones, the surgeon’s impression was agenesis of the gallbladder.
The patient returned to the hospital five days after surgery with complaints of severe RLQ pain, and suprapubic pain that was sudden and sharp. A couple of days later, the patient had an ERCP with a biliary stent placement, followed by another diagnostic laparoscopy performed by the previous general surgeon. This procedure also converted to an open laparotomy with placement of a JP drain in the sub-hepatic area.
Less than a week after presenting to the hospital, the patient was transferred to another hospital and underwent numerous ERCPs with biliary dilation and stent change. Subsequently, a Roux-en-Y hepaticojejunostomy was performed.
The plaintiff’s experts testified the defendant radiologist incorrectly interpreted the abdominal ultrasound report and failed to recommend additional radiology studies. A radiology expert for the defendant radiologist testified he agreed with the interpretation by the defendant radiologist. A defense expert, who was a general surgeon, stated agenesis of the gallbladder is extremely rare, and that the condition was something he had not seen in any radiographic report. He testified the general surgeon could have ordered additional diagnostic testing, which would have determined the agenesis of the gallbladder without the patient having to undergo multiple surgeries.
Verdict:
The jury returned a defense verdict in favor of the defendant radiologist. The defendant radiologist did not visualize the gallbladder, and had reported that in the body of the ultrasound report.
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