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Fig. 22 | Insights into Imaging

Fig. 22

From: Errors, discrepancies and underlying bias in radiology with case examples: a pictorial review

Fig. 22

taken from the same slice levels of CTA (c) were less obvious to diagnose due to artifacts secondary to inadequate breath-holding. Higher spatial resolution with shorter imaging time of CTA enabled the radiologist to make an accurate diagnosis. As in this case, choosing the wrong technique or modality may decrease the possibility of detecting abnormal findings, cause a delay in diagnosis, and sometimes even make diagnosis impossible. However, in this particular case, the change in the diagnosis did not change the patient management to a great extent and did not cause any apparent harm

Delay in diagnosis with no apparent harm. A 45-year-old male patient presented at the clinic with jaundice and recurrent cholangitis history after liver transplantation. Due to persistent itching and progressive jaundice, percutaneous transhepatic cholangiography (PTC) was performed for biliary drainage. PTC showed multisegmental involvement with dilated and stenotic biliary ducts (red arrows, a). Contrast-enhanced upper abdominal MRI and MRCP for evaluation of the biliary tree were reported as “Chronic cholangiopathic changes due to recurrent episodes of cholangitis” without any differential diagnoses. The clinicians suspected "ischemic cholangiopathy" due to liver transplant history and ordered abdominal CTA to rule out ischemic etiology. The CTA, which was performed two weeks after MRI, revealed hepatic artery occlusion (blue arrows, c, e) and arterial collateralization (yellow arrows, c, d). After confirmation of “ischemic biliopathy”, the previous MRI was evaluated retrospectively. The MRI images (b)

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