Heather Wolfe published a Teachable Moment in JAMA Internal Medicine today. She presents a woman with clinical early stage- breast cancer who received needless staging imaging, and was found to have an adrenal incidentaloma. This led to a ‘diagnostic cascade’ of further imaging, biochemical testing and patient anxiety regarding the possibility of metastatic disease. This case highlights the harms that can result from ‘well intentioned’ seemingly benign steps such as unnecessary imaging.
A 63-year old white woman with end-stage renal disease secondary to long-standing hypertension on unscheduled dialysis, atrial fibrillation on warfarin, and hyperlipidemia presents with a painful, ulcerated lesion with purpuric borders, surrounding retiform purpura, and central eschar. Biopsy demonstrated calcifications of small and mediam sized arteries with necrosis of the subcutaneous fat.