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 2019 Case in Point Case of the Year, "Diagnosis: Gallstone pancreatitis complicated by hydropneumothorax," 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?
We selected this case because we had never seen a hydropneumothorax develop as a complication of pancreatitis. The other case report I found was from 1968.

What should readers learn from this case?
Complications of pancreatitis can become chronic and extend to multiple compartments of the body.

What did you learn from working on the case?
Sindy: After we started working on the case report, the revised Atlanta criteria classification was published. We had to integrate this classification into our case discussion.

Jason: Working on this case helped me understand how to look at images more critically in a systematic fashion. As an ER doctor, reading our own images and being confident without waiting for an official read can be a huge advantage in decreasing morbidity and mortality simply by knowing what is usual vs unusual.

How did guidance from senior staff at your institution impact your learning and case development?
I want to thank Dr. Jude for her guidance in this case. She has imparted to me the importance of being thorough and to include numerous modalities to best illustrate the findings.

Why did you choose Case in Point for submission of your case?
While I was a resident, I always enjoyed Case in Point. It seemed like a good opportunity to give back to the radiology community.

Are you a regular reader of Case in Point? What are your favorite types of cases?
Sindy: Yes. My favorite cases are the ones from sub-specialties outside the comfort zone of my fellowship and current practice (body / ER), so I can keep up my knowledge.

Jason: A site like Case in Point is great because it features cases that may present in novel or unusual ways. Many ER patients present with abnormal signs or symptoms and CiP can help us better reach a diagnosis by becoming familiar with the many different ways a patient may present with a similar disease process.

What else should we know about the case that you’d like to share?
The thing I take away most from this case is the fact that there are many things we haven't seen or encountered in medicine, that we will all deal with from time to time. But, looking at patterns and signs/symptoms we do recognize can often times be just as important in bettering the outcome in a patient's life.

Congratulations to all case contributors. The College could not maintain such a high level of quality without a steady supply of incredible cases.

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