BOSTON, MA – According to the abdominal CT scan report internist Dr. Sam Erikson just pulled up, master radiologist Dr. Bart Waddell has once again demonstrated his uncanny ability to hedge on every conceivable diagnosis when reviewing an imaging study.
With the finesse of a watchmaker and the creative dexterity of a modern day T.S. Eliot, Dr. Waddell has successfully raised all known disorders as possible etiologies of the findings visible on the scan. “The process in the right lower quadrant is suggestive of appendicitis,” reads the report, “but fat stranding may also be characteristic of inflammatory bowel disease or mesenteric adenitis or PTLD. Other etiologies of inflammation cannot be excluded. Trace fluid may be present. Mild regurg.”
“Constipation should enter the differential,” adds Waddell. “And shingles.”
Coming in at seven pages and more than 10,000 words, the thoroughly vague report will doubtlessly change not a single important aspect of care for Dr. Erickson’s patient. “The intestine is mildly dilated and collapsed with thick or thin walls and most organs have areas of abnormal or normal enhancement,” continues the report, “so small bowel obstruction and organ pathology must be considered. And tuberculosis.”
“Also, cancer. Could be cancer.”
In awe at the sheer skill necessary to generate such an impressively unhelpful interpretation of a series of 194 static pictures, Dr. Erickson can only shake his head in wonder as he read the beginning of the fourth paragraph: “Diabetic nephropathy, VSD, ASD, and early-onset Alzheimers remain a concern. Semi-positive triangle cord sign, football sign, salt and pepper sign, soap bubble sign, moya moya sign, hot nose sign, eye-of-the-tiger sign, hot cross bun sign, and Medusa head sign. Findings are suggestive of achalasia, bipolar disorder, or possibly avascular necrosis of the femur. Mild evidence of scimitar syndrome and progeria is present.”
The twelfth paragraph, a solitary word, reads simply “Herpes.”
Ultimately, Waddell concludes his dictation with his signature signoff: “Clinical correlation required.”
After reading the report, Dr. Erickson no doubt will follow the usual routine for an internist by ordering all lab tests and getting consults from gastroenterology, surgery, neurology, psychiatry, infectious disease, pulm, pediatrics, geriatrics, cardiology, IR, urology, heme-onc, ortho, chiropracty, and podiatry.