Radiologist's Vigilance Uncovers Dangerous Chest Tumor After Normal ER X-Ray

A 32-year-old man from Haifa was diagnosed with lymphoma in his chest days after a chest X-ray at the emergency room was interpreted as normal and he was discharged. The tumor was discovered during an ultrasound exam at a Maccabi clinic in Haifa, where an unusual blood clot was detected in a major vein in his neck. The patient had initially sought medical attention for swelling near his collarbone, pain, and severe weakness. Despite the normal ER imaging, his symptoms persisted, prompting a soft tissue ultrasound.

During the ultrasound, radiologist Andrea Gabison noticed a color difference in the patient's hand on the swollen side, raising suspicion despite no abnormal findings in the soft tissue itself. She immediately consulted vascular imaging specialist Dalia Garini via real-time video call. Guided by Garini, Gabison examined the blood vessels and identified a thrombosis in a central neck vein responsible for draining blood from the head and neck.

Following this discovery, the patient was urgently referred to Carmel Hospital for further imaging and biopsy, which confirmed lymphoma in the upper mediastinum, the central chest cavity between the lungs containing major blood vessels. The tumor had invaded blood vessels, causing the clot in the neck vein. Garini emphasized that such thrombosis is rare and often signals a deeper problem like tumor pressure on vessels, necessitating prompt investigation.

Gabison reflected, "From the start of the exam, I felt something was off. I didn’t find a direct cause for the swelling but noticed the color change and knew I had to consult." The joint effort and immediate consultation enabled rapid diagnosis and referral for treatment. Maccabi highlighted that this collaboration was crucial in identifying the dangerous condition early despite the initial normal ER results.