Trusting Her Instinct Helps Find Serious Condition
When Binh Phong, ARDMS, performed a gallbladder ultrasound on a patient with upper abdominal pain and vomiting, she knew in her gut that something wasn’t right.
“When I scanned the right upper quadrant, I found duct dilatation in the liver and her gallbladder looked abnormal,” said Binh, a sonographer at Texas Health Presbyterian Hospital Dallas. “But I didn’t stop there. I knew something was causing an obstruction, because the intrahepatic bile duct (which drains bile from the liver) appeared dilated.”
Second opinion
When Binh couldn’t find the cause, she asked Emily Rodriguez, AAS, RDMS, RVT, ultrasound team lead, for help.
“We normally stick to solid organs when we do ultrasounds on adults, so we don’t normally look at bowels,” Emily said. “But I have a background in pediatrics, where we do image them frequently.”
Emily said she saw a dilated portal vein, a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. She suspected a volvulus, which means a loop of intestine has twisted around itself, resulting in a bowel obstruction. The condition affects only two to three Americans out of 100,000.
Suspicions confirmed
Emily showed the scan to the radiologist, who ordered a CAT scan of the area to confirm.
“It was exactly what I thought it was,” Emily said. “She came to the Emergency Room in the morning, and was in surgery that afternoon.”
Emily said it’s uncommon to spot a volvulus on an ultrasound of an adult because bowel ultrasound is more limited than in pediatric patients.
“I really applauded Binh, because she wasn’t afraid to say that something seemed off, but she didn’t know what was going on, and to take that extra step and ask for help,” Emily said. “Most patients would probably be sent home.”
Teamwork works
Binh and Emily’s diligence probably saved the patient’s life, said Cardell Velez, MBA, R.T.(R)(N)(CT)ARRT, NMTCB(CNMT), director of medical imaging services at Texas Health Dallas and vice chair of radiology HOI (hospital operations innovation).
“ER visits for patients like this often stop at ultrasound if nothing else is found,” he said. “I think it was a great example of the team using the Error Prevention Tools – both CUS (I’m concerned, I’m uncomfortable, this is a safety issue) and Cross Check.”
Binh said teamwork is the norm for her and her co-workers.
“We always work as a team to get the best imaging and results for our patients,” she said.
By Robin P. Loveman • Posted January 14, 2020
