How a Large and Significant Radiographic Lesion May Cause You to Overlook Smaller Lesions in the Margins of the Image.

Abstract

This article delves into the challenge of identifying subtle radiographic lesions overshadowed by prominent ones, emphasizing the importance of a comprehensive approach. Using a clinical case as an example, it highlights how focusing on a significant lesion can lead to diagnostic tunnel vision, potentially overlooking other pertinent details. By exploring this phenomenon, the article aims to enhance radiographic interpretation skills and promote a more meticulous approach in the field of radiology.

?Introduction

?This paper delves into the nuances distinguishing large, significant radiographic lesions from smaller lesions located in the marginal zones of radiographic images. The presence of a substantial radiographic lesion, both in size and importance, can inadvertently divert attention away from the smaller lesions positioned at the margins of the radiograph. This phenomenon can lead to diagnostic errors, akin to "tunnel vision."

?Initially, two radiographs of the pelvis and femur were received for teleradiology report, after observing suspicious fracture lines in the proximal metaphysis of the tibia, radiography of the tibia was requested to perform.

?The crux of this report does not revolve around femoral fracture but the incomplete fracture of the tibia, a condition that might easily escape notice and diagnosis. This oversight occurs because the main fracture and the mass of radiopaque stools cause the mind and thoughts to deviate towards that more important and severe clinical fracture, and also the clinician, the answer to his/her question. The clinician finds that it was a femoral fracture and ignores the rest of the radiograph.

History and case presentation

History: Sepid, a native white dog, approximately 3 months old, experienced an accident the previous night. Despite the mishap, Sepid maintained regular food and water intake and continues to excrete urine and feces. During clinical examination, a thigh fracture in the right leg was identified. Subsequently, radiographs of the pelvis and right femur were prepared and submitted for teleradiology. The radiographs are of proper quality.

?Findings: Complete overriding fractures are seen in the right femur. A comminuted fracture of the proximal metaphysis of the right tibia is identified. An incomplete fracture line is found in the mid-diaphysis of the right tibia. No other radiographic abnormality is seen and other anatomic regions appear normal. The caudal abdomen is included and the descending colon is full of radiopaque stool. The diagnosis and conclusion are fractures of the right femur and right tibia based on radiographic findings.

Discussion

This paper primarily focuses on the potential hazards associated with diagnostic errors in the field of radiography, particularly when some findings are located outside the expected region of interest. This occurrence might be likened to the concept of "tunnel vision" or the loss of peripheral vision.

Tunnel vision (peripheral vision loss)

Tunnel vision is a lack or loss of peripheral vision that only allows you to see objects directly in front of you. You can simulate severe tunnel vision by covering one eye and using the other to look through the cardboard tube of a roll of paper towels.

Upon initially receiving two radiographs of the pelvis and femur for radiological interpretation, it was identified suspicious fracture lines in the proximal metaphysis of the right tibia. radiographs of the tibia revealed multiple incomplete fractures in the proximal metaphysis of the tibia. Although the thigh fracture is unquestionably the most serious and visible, it is important not to overlook the accompanying referral or small lesions.

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Alireza Ghadiri

Professor, DVM, DVSc

Board Certified Veterinary Radiologist

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