Delayed Diagnosis of Cancer

Incidentally found lung nodule results in death after delayed diagnosis of cancer, lack of follow-up imaging, and treatment.

BACKGROUND

Incidental findings are common in all forms of medical imaging. An incidental finding a finding that was not the intended finding of an imaging study, and frequently is seen in an organ not intended to be imaged but was included in the field of view. For example, a patient has a lumbar spine MRI for back pain, but a portion of the kidney is included in the image and renal lesions (such as renal cell cancer) can be seen. Lung nodules are one of the most common incidental findings, and can be seen on CT’s of the abdomen, CT’s of the spine, and certainly on CT’s of the Chest as a finding that was not causative of the patient’s initial symptoms. When incidental findings such as lung nodules are demonstrated, they must be closely followed up as lung nodules can frequently be caused by cancer.

CASE

A 82-year-old woman made a visit to her primary care provider for respiratory problems.  A routine chest radiograph exposed a pulmonary nodule where she then had a CT scan.  While the patient’s suspicious nodule was confirmed, her primary care provider did not schedule any additional diagnostic or therapeutic care.  Throughout the next year, the woman endured an assortment of progressive respiratory and cardiac symptoms in which she ultimately underwent coronary artery bypass grafting.  A suspicious lymph node was biopsied during the patient’s surgery.  This lymph node verified to be a malignancy originating from the initial nodule.  Three months later, the patient passed away as the result of a large cell neuroendocrine tumor of the lung.

ELITE’S ROLE

Our physician-led team was asked to secure an ONCOLOGY expert witness with expertise in lung cancer, and experience in small-town medicine to review the facts of the case and determine if the delay in care was causally linked to the ultimately devastating outcome.  The ONCOLOGY medical expert was also asked to determine what, if any, changes to the course of treatment could have prevented or significantly delayed the patient’s death.

THE MEDICAL EXPERTS

ELITE rapidly secured a top-tier professor of ONCOLOGY to review the medical records and determine if any changes in the course of treatment could have led to an improved outcome for the patient.

OUTCOME

The ONCOLOGY medical expert witness opined that the size of the nodule at original presentation should have necessitated additional work up such as biopsy. When found early and at a small size, the tumor was likely to not be metastatic, and the delay in treatment to a reasonable degree of medical probability led to the patient’s death. Given a positive causation opinion, Elite recommended to secure experts in Primary Care Internal Medicine and Radiology to review the case regarding standard of care. Both opinions were found to be favorable for the plaintiff. The Primary Care Internal medicine physician should have coordinated follow-up for the patient, and that lack of follow-up did not meet the standard of care. The Radiology medical expert opined that specific imaging and treatment recommendations should be made in the case of lung nodules, and in this case no such recommendations were made by the Radiologist.

FUTURE ENGAGEMENTS

The all inclusive approach in this case provded invaluable to the client. Elite followed the case from start to finish, continuing to support it throughout each phase of litigation. Using this model, the attorney’s practice has become more streamliend for all personal injury and medical negligence cases.

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E-CASE STUDIES are brief clinical vignettes based upon actual cases handled by ELITE. Identifying information has been redacted or altered to protect case confidentiality.

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