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Published on: March 2, 2020
Delayed diagnosis of a piriformis abscess due to hyposkillia and communication error
Taiju Miyagami1, Arisa Takada2, Taro Shimizu3
1General medicine, Juntendo Daigaku, Bunkyo-ku, Japan tmiyaga@juntendo.ac.jp.
Abstract:
A 69-year-old man with dementia presented to our hospital with fever and left back pain. He was diagnosed with acute pyelonephritis based on microscopy and CT findings indicating bacteriuria and elevated fat density around the right kidney, respectively. Three days post admission, the diagnosis of a urinary tract infection was queried and the patient was re-examined. Marked tenderness was observed in the left buttock; contrast CT scan was subsequently performed and a left piriformis abscess was diagnosed. This diagnostic delay occurred due to a communication error-the referral letter to the radiologist stated 'fever and back pain'-and the physician's hyposkillia; hence, differential diagnoses were not considered. Physicians can reduce the frequency of related errors by conducting proper physical examinations and not relying on imaging findings alone. Furthermore, to ensure accurate diagnoses, the comments to the radiologist should be clear and detailed when requesting diagnostic imaging.
Insights
A misdiagnosis of acute pyelonephritis occurred due to communication errors and physician hyposkillia. A piriformis abscess was later diagnosed after reassessment, highlighting the need for thorough physical exams and clear radiologist communication.
Area of Science:
- Medical Diagnostics
- Radiology
- Infectious Diseases
Background:
- A 69-year-old male patient with dementia presented with fever and left back pain.
- Initial diagnosis was acute pyelonephritis based on urinalysis and CT scan findings.
Observation:
- A diagnostic delay occurred due to a communication error and limited differential diagnoses considered.
- Re-examination revealed tenderness in the left buttock, prompting a contrast CT scan.
Findings:
- A left piriformis abscess was diagnosed, differing from the initial urinary tract infection diagnosis.
- The diagnostic delay was attributed to an incomplete referral note ('fever and back pain') and physician hyposkillia.
Implications:
- Accurate diagnoses require comprehensive physical examinations and avoiding over-reliance on imaging alone.
- Clear and detailed communication with radiologists is crucial for effective diagnostic imaging requests.
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