IP is a 73-year-old gentleman who was seeing his primary care doctor regularly back in 2022, Routine carotid ultrasound found non-occlusive carotid stenosis November of 2022. This report also showed three soft tissue nodules and masses to his right neck area measuring approximately 2 cm x 2 cm each.
SCREENSHOT OF REPORT ATTACHED
The radiologist mentioned they were suspicious and to consider a biopsy.
IP has f/u visit to his primary in March of 2023, which was his 6-month follow-up. The physical exam says his neck was "normal" and there was no mention of these masses found, no referral.
The IP informed us that at that time, he had decided to retire and did not have medical coverage between March of 2023 and going into late 2024. He stated no reason to seek medical tension until November of 2024, when he felt a new large lump on his right neck. He sought a new physician who then immediately referred him for CT, which then turned into a biopsy, which (by early 2025) was diagnosed as metastatic basaloid squamous cell carcinoma of the head and neck. IP underwent chemotherapy and recently had a PET scan which showed some reduction in size of the masses, however he does have metastasis to his lungs and into his abdominal cavity.
The physician in question is certified in internal medicine and practicing as a primary provider in a large clinic-based practice.
Our questions concern the lack of escalation and/or further investigation of the abnormal neck findings found on the U/S.
Any questions welcome. Thank you in advance.
Files:
No questions yet!
Do you believe there might have been medical error?
Given the concern expressed by the radiologist in the radiology report, a referral for biopsy to either general surgery, ENT, or interventional radiology would have been warranted. At the very least, this should have been a discussion with the patient who should have been made aware of the findings and encouraged to investigate further. The prior PCPs records should be investigated to determine whether it was documented that any such conversation took place and whether any further assessment was sought, and if not, why.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Of course, in this situation, the medical error did not cause the cancer, but the delay in diagnosis may have allowed the cancer to continue to grow, which complicates treatment options. So, the delay in care here represents the mechanism for possible harm.
What makes you a good expert for this case?
I practiced primary care for the previous 5 years and am a board-certified internal medicine physician. These were the type of incidental findings that we saw on imaging and lab reports all the time that required further workup if the patient was agreeable to doing so.
How often do you encounter cases similar to this one in your practice?
During my previous several years of practice, we would see incidental findings such as this routinely.
Do you believe there might have been medical error?
here, he was not investigated for a possbile malgnancy. Head and Neck cancer or a lymphoma. It needed to be investigated
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
we do not have info if this is a HPV+ ve cancer. itf so, there is a a big causation. If it is HPV neg, they tend to recur in about 40% mainly to lung. So either way there is causation
What makes you a good expert for this case?
I am an expert in Head and Neck cancer. I have testified for defense and reviewed cased for Plaintifs
How often do you encounter cases similar to this one in your practice?
it is quite often as I do a lot of Head and neck cancer and I do review cases
Do you believe there might have been medical error?
As soon as these neck were found, patient should have been referred to specialist or had next CT performed
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
this is pretty clear.. in 3/23, PCP should have addressed these neck masses
What makes you a good expert for this case?
I send patient was for carotid ultrasounds on a daily basis and very frequently have to deal with these findings that are not cardiac but are obviously consequential
How often do you encounter cases similar to this one in your practice?
I frequently fine thyroid nodules on my carotid ultrasounds and will refer to PCP, endocrine for further evaluation
Do you believe there might have been medical error?
The US in Nov 2022 showed a tumor/mass and there is no documentation of further work up by the ordering physician.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Not doing any further work up for this tumor since nov 2022 (assuming PCP knew about it) it may be considered an error. Physicial exam in march 2023 was "normal" or this was also an error? Any other doctor this patient visited?
What makes you a good expert for this case?
15 years seeing patients as a physician I have to follow up all results that i ordered on patients and calling them. I do not think i would ever not paid attention to a mass in an US. At least, i would have called the patient.
How often do you encounter cases similar to this one in your practice?
I have found incidental findings on patients like lymph nodes, and a follow up is always needed to determine growth or resolution.
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