Page Section: Left Content Column
Page Section: Centre Content Column
Misdiagnosis of pyogenic abscess as hydatid cyst (01HDC07116)
Download Misdiagnosis of pyogenic abscess as hydatid cyst (01HDC07116) (PDF 14Kb)
(01HDC07116, 13 January 2004)
Surgical consultants ~ House
surgeon ~ Registrars ~ Radiologist ~ General surgery ~
Communication ~ Misdiagnosis ~ Right 4(1)
An independent 76-year-old woman presented to her GP with a
painful lump in her kidney region following a fall several days
earlier. An ultrasound was performed and the patient referred to
the surgical outpatient department for assessment. The patient
presented to the Emergency Department 12 days later, her referral
having been classified as non-urgent. She was admitted by the
surgical house surgeon and seen by the consultant the next day.
Provisional diagnoses included a hydatid cyst, myosarcoma or a
secondary tumour. An abdominal CT scan was ordered that day,
requesting "locate lump, suggest diagnosis".
The CT report noted that the lump was in keeping with the
suggestion of a hydatid cyst. The radiologist later confirmed that
his role was to report on what he saw, not to make a diagnosis. The
CT report was not seen by the consultant, but relayed to him
verbally by a member of his team. He formed the view that the CT
had confirmed that the patient had a hydatid cyst.
Despite concerns raised by the patient's family, and documentation
in her notes that she was considerably unwell, the consultant
discharged her home two days after the scan. Following discharge
she continued to deteriorate and the lump grew. She was readmitted
one week later and placed under the care of a consultant colorectal
and general surgeon, as the original consultant was on leave. The
patient's condition continued to deteriorate and eventually, after
the diagnosis was questioned, a decision was made to aspirate the
lump. However, the aspiration was delayed because of a breakdown in
communication as to when handover back to the original consultant
was to occur. In the meantime, the patient's condition deteriorated
The aspiration obtained pus, and the patient was taken to theatre
for drainage of the abscess. She was admitted to ICU, where she
developed problems with the right side of her chest. She declined
ventilation and died several days later.
The patient's niece complained that medical staff had misdiagnosed
the patient with hydatids, and that she was inappropriately
discharged from hospital when she was still ill.
It was held that the original surgical consultant was in breach of
Right 4(1) of the Code. In making his decision, the Commissioner
outlined the following points:
• With respect to the reporting of the CT scan, it was unwise
for the consultant to uncritically accept the advice given to him
by his team member - the consultant was unfamiliar with hydatid
cysts, and this was an extremely unusual diagnosis. On receiving
the information he should have discussed the matter further with
• There was insufficient clinical evidence to rely on the
diagnosis of hydatids without entertaining other diagnoses.
• The consultant failed to ensure that his registrar spoke
directly to the second consultant, rather than the second
consultant's registrar. Had that communication occurred and the
second consultant been made aware of the clinical situation, he
would have questioned the diagnosis.
• Discharging the patient without a definitive diagnosis, and
in the presence of abnormal test results and concern from staff and
family that she was still very unwell, was a failure to exercise a
reasonable standard of care.
Neither the colorectal and general surgical consultant nor the
hospital was found to have breached the Code.
Page Section: Right Content Column
Top of Page