Fig. 17

Framing bias causing an under-reading error. A 77-year-old female patient with a history of renal stone and recurrent urinary tract infections presented with lower abdominal pain. The patient’s symptoms did not regress under proper antibiotherapy. Non-enhanced CT was ordered for “evaluation of renal stones and urinary pathologies.” The CT was reported as “normal, except left atrophic kidney (red arrows, a).” However, a collection (blue arrows, a, b), free-air bubbles (yellow arrow, b) and mesenteric fat stranding (green arrows, a, b) adjacent to the sigmoid colon were overlooked due to the framing of clinical information. Although non-enhanced CT was technically inadequate to evaluate bowel pathologies, inflammatory changes were clearly visible on CT, and at least a suspicion should have been expressed. During follow-up, lower abdominal MRI revealed the final diagnosis as “perforated sigmoid colon malignancy” (not shown)