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 detected during an ultrasound examination at a Maccabi clinic in Haifa, where an unusual blood clot was found in a major vein in his neck. The patient initially sought medical help due to swelling near his collarbone, pain, and severe weakness. Despite the normal ER X-ray, 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 remotely, Gabison identified a thrombosis in the neck vein, a rare condition involving a blood clot in a central 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. Garini emphasized that such thrombosis can indicate deeper issues 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 clear cause for the swelling but noticed the color change and knew I had to consult an expert." Maccabi highlighted that the collaborative approach and immediate consultation enabled rapid referral and diagnosis, potentially saving the patient’s life.