EXPERTISE IN INTERPRETATION OF CT-ANGIO IS REQUIRED TO COMMENT ON THIS CASE.
53 yo woman after rigorous work experiences some chest pain and goes to ER. By then pain has subsided. She tells them she had a CT Angiogram 5 1/2 months prior that was completely normal and it is part of her electronic record. Indeed that report states "No significant plaque" in any coronary artery and Agatson Score of 0 in all coronary arteries. They order another. It is read by an "outside" Radiologist on his laptop at home and he finds "moderate atherosclerotic disease with worst lesions seen in the proximal LAD and mid LCX (50-69% decrease in luminal diameter and mild disease at the proximal RCA (less than 50% decrease in luminal diameter."). Agartson score was again 0 in all coronary arteries. Stating that "Your cardiac CT Angiogram indicated a progressive change from your prior CCTA," they transfer her emergently to a Level III hospital for cardiac catheterization. This is done and the result of the procedure is "no evidence of significant disease" in any of the patient's coronary arteries. Unfortunately the patient suffers a major complication during the procedure. Assuming you find that the outside Radiologist misread the CTA (I have been told the quality is poor and undiagnostic), I need you to so testify in mid June. Obviously expertise in reading CTAs is a requirement. Compensation for preparation and court appearance are a given.
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Do you believe there might have been medical error?
I only give it an 8/10 because I haven't seen the report and images firsthand. However an Agatson score of 0 implies no calcification. This means any luminal stenosis is low density implying partially occlusive non-calcified thrombus, which would be a pretty unusual thing in an otherwise healthy 53 year old woman. Its possible that artifact was misinterpreted as this, but I won't be able to say for sure until I see the images and report. Sounds like a mess of a case because if she had negative troponins and EKG they should have given some pause. Also, did she have a coronary dissection, or pseudoaneurysm as the complication? Could also be a fault of the cardiologist there too.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If they depended on the coronary CT for a decision to cath, that directly led to the cath, which then led to a complication (bad luck or otherwise). Would be curious to know what the complication was as well.
What makes you a good expert for this case?
I am an academic radiologist at UCLA with expertise in Acute Care imaging. Coronary CTs are often used in the ER to evaluate borderline cases, triage low intermediate ACS patients. I have had training in Diagnostic Cardiovascular Imaging during my fellowship at UCLA.
How often do you encounter cases similar to this one in your practice?
I have never seen a person misread a coronary CT like this (if true), theyre usually pretty straightforward. I would have to see the images myself. But Coronary CTs, yes I am comfortable reading them and they are performed at my institution.
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