Most Frequently Missed Diagnosis: Retropharyngeal ...

Most Frequently Missed Diagnosis: Retropharyngeal Suppurative Lymphadenitis

J Shah, MD; L Lanier, MD; C L Sistrom, MD; D Rajderkar, MD; A Ghaffari, MD; A Mancuso, MD;I M Schmalfuss, MD

University of Florida, Department of Radiology Contact: shahjl@radiology.ufl.edu

The authors have no financial disclosure in regard to this educational exhibit.

Background:

Computer aided online simulation (SIM) of emergency imaging studies was developed

Designed to test residents for readiness for call Providing proficient & objective assessment of

resident competence in the emergency/critical care imaging & affirmation of milestone achievements

Background:

8 hour simulation of 65 emergent & critical care cases of varying degrees of difficulty, including normal studies

Presentation via full DICOM image sets Dictation of free responses into text boxes labelled:

o Critical findings o Incidental findings o Acuity ranking

Results:

SIM was taken by 103 first (R1) & second (R2) year residents from 9 USA radiology training programs in 2014

Suppurative retropharyngeal space (RPS) lymphadenitis was presented

o 100% of residents failed to make the correct diagnosis o Incorrect answers included:

? RPS abscess (48%) ? Peritonsillar abscess (24%) ? Tonsillar abscess (15%) ? Abscess without localization (1%)

Results:

SIM was taken by 103 first (R1) & second (R2) year residents from 9 USA radiology training programs in 2014

Suppurative retropharyngeal space (RPS) lymphadenitis was presented

o 100% of residents failed to make the correct diagnosis

Conclusion: Significant cognitive gap exists in differentiating suppurative RPS lymphadenitis from abscess placing patients at risk for unnecessary surgical

procedure

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