Sample Case Evaluation Reports - Radiology Expert Witness

Arteriogram Via the Oxillary (armpit) Artery Causes Injury With no Repair Done.

Certain salient aspects of this case are summarized below.

1) This Patient was 64 years old on March 3 when he underwent a balloon angioplasty of the proximal superficial femoral artery due to an ischemic left leg. This procedure was performed by Dr. Smith of Hospital #1. The details of this hospital admission were incomplete and no Informed Consent form was available for review. The signs and symptoms that he experienced due to this left leg arteriosclerosis, or "hardening of the arteries", were also unavailable.

2) The technique that Dr. Smith used was an axillary artery approach through the armpit, into the aorta and through the previous graft of the proximal superficial femoral artery. During this procedure, Dr. Smith noted a stenosis, or blockage, with difficulty passing this catheter, but an eventual successful balloon angioplasty with restoration of good arterial blood flow was achieved. During such a procedure, a narrowed artery is expanded using a catheter, which inflates a balloon-like device to widen the diameter of this blood vessel. Follow-up left leg ultrasound scanning on March 17 revealed improved blood flow, or at least a partially successful procedure.

3) Almost immediately in the postoperative period, he experienced left arm pain which was treated with pain medication. These records are also incompletely available and should be obtained. On March 6 he was evaluated by Dr. #2 of the Emergency Ward for continued left arm pain. Examination revealed motor and sensation abnormalities of several of his fingers. The case was discussed with Dr. #3 following a duplex-imaging scan revealed a partially clotted pseudoaneurysm of the left axillary artery. This is a known and usually preventable complication, but since it was causing symptoms, urgent surgery was indicated. For reasons that are unclear, no acute intervention, such as a decompression was felt to be indicated at that time, although the report of Dr. #4, the Radiologist, indicated a possible need for surgical repair.

4) This patient has been suffering from significant left arm weakness and median as well as ulnar nerve denervation symptoms since that time. He has been evaluated by several physicians, including Dr. #5 of the Hospital #2. In his note dated September 20, Dr. #5, a Neurosurgeon, recommended a probable need for decompressive surgery of the brachial plexus. Unfortunately, no further medical records were available following this date. 

In summary, patient underwent a balloon angioplasty procedure by Dr. Smith on March 3. It is unknown if this procedure was performed following proper informed consent, including the risks, benefits and alternative treatments to this procedure. It is also unclear if this procedure was performed using optimal precautions, and techniques, such as fluoroscopy, to avoid such complications as damage to the axillary artery and resultant nerve compression of adjacent nerve trunks. Following this postoperative complication, negligent Emergency Ward care appears to have been delivered by Drs. #2 and #3 as decompression surgery was delayed or omitted. Finally, he was evaluated on several occasions by Neurologists such as Dr. #6 and definitive decompressive surgery was again delayed or omitted.

In this specific case, Expert opinions in the areas of Vascular Surgery, Emergency Medicine, Neurology and Neurosurgery should be strongly considered to further bolster the merits of this case. However, it will also be helpful to obtain a more complete set of medical records.

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