Archived case 195 · February 4-February 11, 2016
70 y/o male, COPD, Evaluate for Mass. No prior imaging.
What are the salient radiographic findings? What would be your next step?
Findings: The frontal radiograph demonstrates right hemithorax volume loss with a possible mass and architectural distortion in the right suprahilar region. Right apical bullous change versus cavity also seen. Incidentally noted is a catheter fragment overlying the expected course of the left pulmonary artery and extending toward the left lower lobe. CT axial and coronal images confirm a retained catheter within the left lung arterial circuit. Answer Diagnosis: Incidental retained pulmonary arterial catheter
Incidental retained pulmonary arterial catheter
Discussion: The purpose of this case is to emphasize the importance of analyzing every image in its entirety. There are times when the given history can cause a radiologist to focus on only one thing, in this case looking for a mass. When the primary objective is completed, i.e. a mass is discovered, there is a tendency to forget about the rest of the image which can lead to missed secondary findings, as could easily happen in this case. This tendency is known as “Satisfaction of Search.”
It has been shown that a specific abnormality is more likely to be missed when it is accompanied by an additional finding than when it is the only abnormality present. Therefore, it is imperative that all radiologists develop and maintain a thorough and systematic search pattern for all studies so as to limit false negatives which may result in potentially harmful outcomes. Of note, it has also been shown that Satisfaction of Search exists not just in radiology, but also in psychology and even nonmedical fields such as airport security screening.
Additional readings: Fleck M et al. Generalized “Satisfaction of Search”: Adverse Influences on Dual-Target Search Accuracy. Journal of Exp Psychology: Applied 2010, Vol 16, No. 1, 60-71
(Click for a larger image.)
Original case written by its authors at Virginia Commonwealth University and published at this address as part of a weekly teaching collection. Reproduced here as an archive.