2021 CIP Winner

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 2021 Case in Point Case of the Year , “Diagnosis: Hepatobiliary ascariasis,” is an example of the latter.  


Check out the case and then read on to learn more about the Case of the Year and its authors in this Q&A.

Why did you select this case for submission?
This case sparked my interest during my first rotation through body MRI as a second-year resident. I was involved in interpretation of the magnetic resonance cholangiopancreatography (MRCP) upon patient’s transfer from an outside hospital. The case became of immediate educational interest within the department due to its uncommon geographical location for a complication related to a globally common parasitic infection.

What should readers learn from this case?
Healthcare is a team sport with radiology as an integral member. This case exemplifies the significance of appropriate clinical history and use of the electronic medical record to provide value-based imaging care. It is this team approach to healthcare that allows for the best outcomes for our patients.

What did you learn from working on the case?
This case taught me the significance of thinking outside of the box, being able to develop a broad differential, and then use the clinical information provided to help narrow that differential. The MRCP I interpreted solidified the diagnosis allowing for rapid treatment and ultimate clinical improvement of the patient.

How did guidance from senior staff at your institution impact your learning and case development?
One of the primary missions of the department of radiology at the University of Iowa is to provide excellence in teaching. Dr. Stolpen and Dr. Park were instrumental in their guidance from the point of diagnosis all the way through submission to ACR Case in Point.

This case allowed a baseline discussion of the tenants of MRCP, including basic and advanced MRCP differential diagnoses and how to cater additional MRI sequences to provide value imaging care. Further, this case demonstrated the importance of collegial integration and rapport with clinical services, a cohesive body section which works across multiple modalities, and the use of resources such as the ACR to advance the education, practice, and science of radiology. Dr. Stolpen and Dr. Park have and continue to be excellent mentors.

Why did you choose Case in Point for submission of your case?
As members of the ACR and subscribers of the daily Case in Point email, we appreciate the interactive educational platform with a wide audience. The submission would allow us the opportunity to share our case and its educational points of interest ranging from the level of medical students through professor emeritus.

Are you a regular reader of Case in Point? What are your favorite types of cases?
Yes. We highly recommend subscription to the daily Case in Point email. As body imagers and future body imagers, the authors have a natural proclivity toward body cases. We appreciate interactive expansion of our knowledge from rare cases that we may not otherwise encounter on a regular basis. Our favorite cases are those with radiology-pathology correlation.

What else should we know about the case that you’d like to share?
Though ascariasis is a common infection worldwide, affecting approximately 25% of the global population, its presentation in the heartland of America is uncommon. The irony of a parasite with swine as a major host presenting at a hospital in a state with a 7:1 ratio of pigs to humans is not lost upon us. On Iowa. Go Hawks!

The patient was discharged within 1 week after ERCP in excellent condition and has done well since.


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Taylor R. Harms, MD
PGY-5, Radiology Resident
Department of Radiology
University of Iowa
  Robert M. Becker, MD
PGY-6, Body Imaging Fellow, Clinical Scholar
Department of Radiology
Stanford University
 Headshot   Headshot 
 Jinha M. Park, MD, PhD, FACR
Clinical Chief, Oncology
  Alan H. Stolpen, MD, PhD, FACR
Associate Professor of Radiology
Department of Radiology
University of Iowa 



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