Celebrating 2024 Case in Point Case of the Year

Ahmed Elarabi, DO, LT, MC, USNR, General Medical Officer at Naval Medical Center Portsmouth; Rob Nottingham, DO, LCDR, MC, USN, Staff Radiologist at Naval Hospital Jacksonville; and Van Thong Ho, MD, Diagnostic Radiologist at Naval Medical Center Portsmouth, contributed this piece.

In medicine, a diagnosis is not always straightforward. Many diseases or conditions can present in various ways, depending on the circumstances. So how do you train for the uncommon presentations?

Case in Point® allows radiologists to evaluate common findings as well as diseases and conditions that can present in interesting ways. The Case in Point 2024 Case of the Year, Disseminated miliary tuberculosis, is an example of the latter.  

In this blog, we invite the Case of the Year authors to reflect on this fascinating case study. Learn more about the authors’ thought process reading images and presenting this case: 

Why did you select this case for submission?

This case was particularly interesting due to the unusual diagnosis of someone in the United States, as well as the diffuse involvement of nearly every organ system. It was not difficult to choose. We started discussing it and we decided to select this unique case. We had a large collection of multiple images, along with a full history and many helpful pieces of information to share.

What should readers learn from this case?

Keep thinking outside the box, always consider travel outside the country when a diagnosis doesn’t seem to fit the patient’s current living scenario. Tuberculosis (TB) in the United States is rare, and miliary tuberculosis is the rarest presentation of active tuberculosis. This case is also unique because it does not present the typical signs associated with military TB in the chest; however, it has manifested in many other organs.

What did you learn from working on the case?

The impressive multisystem involvement includes pericardial effusions and prostatitis. There is no doubt that radiology is important for diagnosis and treatment; however, in this case, I discovered how challenging it can be to rely on other diagnostic techniques to confirm a diagnosis. The patient was solely diagnosed and treated based on radiology and clinical judgment, as all other labs and biopsies returned inconclusive results.

How did guidance from senior staff at your institution impact your learning and case development?

Our staff helped us work with the inpatient team at our institution for a collaborative, multidisciplinary approach which ultimately allowed for the imaging studies and the confirmatory lab test. Senior staff provide independence for us in completing the case, trusting our judgment and providing final review and polishing of our case.

Why did you choose Case in Point for submission of your case?

Throughout residency, Case in Point has been a staple of our program. It is the most popular platform among radiologists to publish cases and has a strong reputation among our senior staff, which helps improve our career development. Case in Point does a great job of showing classic, can’t miss cases as well as zebras to keep the differential diagnosis healthy. It provides a platform for allowing us to see our peers’ work/efforts at other institutions and see work from past graduates of our own institution. When we see a case with a familiar face at the end, it’s always a topic of discussion. 

Thank you to our Case in Point Associate Editor, Muhammad Aziz, MD, for editing this case.