Misdiagnosis of Malignant Pleural Mesothelioma

Transcription

Misdiagnosis of Malignant
Pleural Mesothelioma
Yun Seong Kim
Division of Pulmonology and Critical Care Medicine,
Department of Internal Medicine,
Pusan National University School of Medicine,
Yangsan, Korea
Definition of Misdiagnosis
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A medical error occurs when a health-care provider
chose an inappropriate method of care or the
health provider chose the right solution of care but
executed it incorrectly
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Medical errors are often described as human errors in
healthcare
Zhang J, Patel VL, Johnson TR. JAMIA, 2002
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Many types of medical error from minor to major
Timothy P. Hofer. ACP, 2000
Introduction
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Malignant pleural mesothelioma(MPM) is an
uncommon neoplasm which is originated from
pleural mesothelial cells
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The majority of MPM is associated with prior
asbestos exposure
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Patients often present with chest pain and dyspnea
due to pleural effusion, which might be diagnosed
with tuberculous pleurisy especially in Korea.
MPM is well known for its poor prognosis with a
median survival time of less than 12 months after
diagnosis
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Case
Presentation
Case 1
M/44
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CC: Lt chest pain for 2M
PI: AntiTB medication for 10 ds → ↑amount of effusion in CXR
PHx : N-S
SHx: Ex-smoker; 30 PY, stop 5yrs ago
FHx: Father – TB Tx
Lab/F
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WBC=21,100/mm3(Neu 75.5%), Hb=14.7 g/dL, Hct=40.8%,
CRP=8.69 mg/dL
AST/ALT=53/162 IU/L, LDH=465 IU/L, TB=0.78 mg/dL,
TP/Alb=6.5/3.2 g/dL, BUN/Cre=18.4/0.7 mg/dL
PF analysis: pH=7.5, WBC=333/mm3 (Neu 75%, Lym 25%),
Protein=4.9 g/dL, LDH 687 IU/L, Glucose=110 mg/dL, ADA=30 IU/L
Case 1
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Delay in Diagnosis: about 2M
Occu: factory dealing asbestos for 6yrs, 20yrs ago
Progress: Chemotherapy at other hospital
Case 2
M/73
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CC: Rt chest pain, dyspnea for 2yrs
PI: Medication for TB pleurisy for 6M 2YA
→ sx aggreviate in recent days
PHx & FHx: N-S
SHx: Smoking (-), Alcohol (-)
Lab/F
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CRP=10.18 mg/dL
PF analysis: pH=8.0, WBC=39/mm3 (Neu 15%, Lym 85%),
Protein=4.1 g/dL, LDH=2,090 IU/L, Glucose=39 mg/dL, ADA=29 IU/L
Case 2
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Delay in Diagnosis: about 2yrs
Occu: factory dealing asbestosis for 30yrs → stop 10YA
Progress: ARF after VATS biopsy → expire on POD #16
Case 3
M/52
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CC: Rt chest pain, dyspnea for 1M
PI: Medication for TB pleurisy started for 20ds
→ sx relief (-)
PHx: N-S
SHx: Smoking (-), Alcohol (-)
FHx: Father – TB Tx
Lab/F
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CRP=10.38 mg/dL
PF analysis: pH=8.0, WBC=2,016/mm3 (Neu 35%, Lym 65%),
Protein=4.6 g/dL, LDH=1,196 IU/L, Glucose=79 mg/dL, ADA=42 IU/L
Case 3
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Occu: Welding factory for several yrs
Progress: supportive Tx
Case 4
M/73
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CC: cough, dyspnea for 5M
PI: Evaluation at other tertiary hospital
→ recommend surgical Bx → refuse
PHx & FHx: N-S
SHx: Smoking (+): 50PY, Alcohol (-)
Lab/F
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CRP=4.11 mg/dL
Pericardial Fluid analysis: pH=7.5, cells=9,230/mm3 (Neu 53%, Lym
18%), Protein=7.5 g/dL, LDH=9,437 IU/L, Glucose <10 mg/dL,
ADA=46 IU/L
Case 4
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Occu: Farmer, dealing with slate works
Progress: Chemotherapy(Pemetrexed + Cis) 9 cycles
Summary
Sex
/Age
Initial Dx
Delay
time
Progress
Case 1
M/44
TB pleurisy
2M
?
Case 2
M/73
TB pleurisy
2Y
Die POD #16
Case 3
M/52
TB pleurisy
1M
Several months
Case 4
M/73
Unknown
5M
Die after 1yr
Methods to reduce error
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Patient's getting a second opinion from another
independent practitioner with similar qualifications
Voluntary reporting of errors
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to obtain valid data for cause analysis
Root cause analysis
Systems for ensuring review by experienced or
specialist practitioners
“Be always suspicious of MPM in
atypical or unknown pleural disease”
Thank you for your attention!!

Misdiagnosis of Malignant Pleural Mesothelioma

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