Failure to diagnose cancerous mass

Presentation

A 62-year-old woman came to a diagnostic imaging clinic for an abdominal and pelvic CT to evaluate her back pain. The CT scan revealed a possible left chest wall mass but required further imaging due to limited visibility. The patient had a history of breast cancer and a left mastectomy approximately 12 years earlier.

Physician action

Three weeks later, the patient had a follow-up chest CT; Radiologist A noted no abnormalities and no evidence of metastatic disease.

One week later, the patient underwent a mammogram of her right breast. The results indicated no suspicious masses or calcifications and normal-appearing lymph nodes in the right axilla.

One year later, the patient discovered a lump under her right arm. A mammogram showed areas of fibroglandular density in her right breast, a benign density and a benign calcification in the right breast, and an enlarged lymph node in the right axilla. An ultrasound showed several enlarged lymph nodes with cortical thickening in the right axilla.

That same day, an ultrasound-guided biopsy of the right axillary lymph node was performed. Pathology confirmed malignant metastatic mammary carcinoma.

A week later, the patient underwent an MRI of the right breast, which captured the same area as the CT reviewed by Radiologist A one year earlier. The MRI identified a 4.3 cm mass in the left anterior chest wall and multiple enlarged right axillary lymph nodes. Bloodwork revealed elevated cancer antigen levels. She was diagnosed with metastatic breast carcinoma.
 

Allegations

A lawsuit was filed against Radiologist A, alleging failure to diagnose a cancerous mass on the left chest wall and enlarged right axillary lymph nodes, which led to the spread of metastatic cancer over the next year.

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Legal implications

Physicians who reviewed this case were critical of Radiologist A’s interpretation of the chest CT. Most concluded that there was a visible mass on the left chest wall but could not identify any abnormal right lymph nodes on the same CT study. One oncologist noted that there is no way to tell whether the patient’s cancer had spread from the left chest wall mass to the right lymph nodes without a biopsy and stated that identifying the mass may not have changed the patient’s outcome.

Another consultant suggested that Radiologist A’s inaccurate reading of the patient’s CT in 2022 led to a delay in diagnosis of a full year. However, several defense consultants stated they were unsure the delay affected the patient’s prognosis.

Documentation was an issue in this case. In Radiologist A’s initial report, he noted that he compared the chest CT to the previous abdominal CT; however, he later claimed that he never saw the initial scans for a comparison. Experts were critical of Radiologist A for not discussing his findings in detail. One radiologist stated that the lack of evaluation of the previous scans likely contributed to the oversight of the left chest wall mass.

Disposition

The case was settled on behalf of Radiologist A.

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