0:00

This is also a very interesting case.

0:02

This was a, uh, incidental finding on an

0:06

outside hospital in a patient who had a fall

0:09

and they saw this and biopsy was done, which came out

0:12

to be non-diagnostic.

0:14

This, the patient was referred to a tertiary hospital

0:17

for further evaluation.

0:19

The surgeon did not see the patient,

0:21

but wanted a repeat biopsy to be done at the hospital

0:25

of the surgeon, which was a, a tertiary care center.

0:28

Uh, the interventionalist

0:31

who saw this scan looked at the older scans on this patient

0:35

and, and that these are some of the studies that they saw

0:37

that it was preva, uh, presacral.

0:41

T one hyperintensity mostly looks like a hematoma

0:45

enhancement pattern is not central.

0:47

It's more peripheral.

0:49

Uh, that's, uh, a patient has had trauma, blah, blah, blah.

0:52

And they, uh, looked at some of these images

0:55

and this was one of the scans that they looked at.

0:58

It was really big presacral presacral hemorrhagic,

1:01

and then it changed a good bit

1:04

and they decided that the biopsy is not really indicated.

1:07

This looks like hematoma may have been infected, that's why,

1:12

um, you see some changes within the bone.

1:15

And they decided not to pursue the biopsy and,

1:17

and the total patient as such

1:19

that it has improved significantly and no need to biopsy it.

1:23

Uh, but they did not tell the referring physician at their

1:27

hospital, and they did not call up the

1:30

outside SA state doctor where the patient was really, uh,

1:34

following with patient felt quite good

1:37

as the patient was not having a lot of pain.

1:40

Felt quite good and did not pursue any further, uh, medical,

1:45

uh, treatment for this,

1:46

or medical opinion for this, uh, till.

1:49

Uh, but, but looking back, uh, at all the images,

1:54

now, obviously this is when the,

1:56

when the lawsuit was brought forth

1:58

and when I looked at all these scans,

2:01

this was the initial scan.

2:02

There was nothing in the, uh, presacral region.

2:05

Everything is in the bone. It is as bright as CSF.

2:09

Uh, so you tend to think about chordoma

2:12

as being the initial diagnosis.

2:13

And then you can see it growing from where it was.

2:17

And the patient then three years later, became, uh,

2:21

loses bladder bowel and has, uh, paraparesis

2:25

and the patient ends up with ectomy

2:28

and you can see the tumor within the sacrum cell.

2:31

That's tumor in the presacral space.

2:34

Brachyury was positive for this patient.

2:36

So obviously this was not good for the physician,

2:41

uh, interventionalist who did not do the biopsy,

2:44

even though was asked to do the biopsy,

2:46

but more importantly, did not talk with the teams

2:51

who had referred the patient over to let them know that,

2:55

Hey, I'm not doing the biopsy, uh,

2:57

for whatever reason came to mind.

2:59

So that, that's, that was,

3:01

that was not good outcome for that, uh, person.

3:03

Unfortunately, I.