Today’s X-Ray

 Posted by on 11 March 2009 at 11:33 am  Fun, Health Care
Mar 112009

History: Leg Pain

Yeah, I bet his leg is a little uncomfortable!

ER History

 Posted by on 3 March 2009 at 1:18 pm  Health Care, Humor
Mar 032009

I worked the “nighthawk” 9pm-7am shift all week not long ago, which is mostly emergency radiology. Here’s a history from a middle-of-the-night CT scan of the head and face that I recently interpreted:

As my on-call partner said, “I’m sure we’re getting paid for that one!”…

Hsieh OpEd in Washington Examiner

 Posted by on 24 February 2009 at 1:06 pm  Activism, Health Care
Feb 242009

The February 23, 2009 Washington Examiner published my latest OpEd entitled, “America Doesn’t Need a Health Care Czar”. Here is the intro:

America doesn’t need a ‘health care czar’

By Paul Hsieh, MD, OpEd Contributor – 2/23/09

KEY DATA: Free market health reforms could reduce health insurance costs by over 50%.

TAKE HOME: President Barack Obama’s plans for a “health czar” would represent an unprecedented and dangerous intrusion of government into the practice of American medicine.

Former senator Tom Daschle’s withdrawal as President Barack Obama‚Äôs nominee for Secretary of Health and Human Services has left the White House administration scrambling to find a new “health czar” to implement their goal of government-run “universal health care.”

But while the primary focus had been on Daschle’s tax problems, Americans should also ask a more fundamental question: Why do we need a health czar in the first place?…

Read the rest here.

As usual, feel free to leave comments on the article website, as well as to forward it to friends, family, co-workers, elected officials, etc.

Update: The OpEd has started a vigorous discussion at LittleGreenFootballs!

Two Hsieh LTEs in Rocky Mountain News

 Posted by on 24 February 2009 at 12:01 am  Activism, Government, Health Care
Feb 242009

The Rocky Mountain News has published two (!) of my LTEs on consecutive days.

On February 18, 2009, they printed this letter opposing the latest proposal for “single payer” health care in Colorado:

Single-payer health care has failed in every other country
Paul Hsieh, Sedalia

Response to your story, “Dems’ bill shoots for universal health care” from 2/5/2009 by Ed Sealover.

Single-payer health care has failed in every other country that has tried it. Canada controls health costs by forcing patients to wait months for MRI scans and cardiac surgeries that Americans can get in a few days.

Single-payer advocates mistakenly claim that health care is a “right”.

Health care is a *need*, not a right. Rights are freedoms of action (such as the right to free speech), not automatic claims on goods and services that must be produced by another.

Instead of single-payer health care, America needs free-market reforms, such as allowing patients to purchase insurance across state lines and use health savings accounts for routine expenses. Insurers should be allowed to sell inexpensive, catastrophic-only policies to cover rare but expensive events.

Such reforms could reduce costs and make insurance available to millions who cannot currently afford it, while respecting individual rights.

On February 19, 2009, they printed this letter on the Obama Administration’s expanded welfare state programs:

Heads they win, tails we lose
Dr. Paul Hsieh, Sedalia

When the economy is bad, welfare statists say, “We must expand government programs because everyone is hurting.” When the economy is good, they say, “We must expand them because we can finally afford it.”

If I didn’t know better, I’d think that they wanted to increase people’s dependency on government programs regardless of the reason.

X-Ray Answer

 Posted by on 18 February 2009 at 11:01 am  Fun, Health Care
Feb 182009

The patient’s heart has been removed!

He is a heart transplant patient about to receive his new heart, and of course the surgeons had to remove his old failing heart first. The film was taken after his native heart had been removed but before the transplanted new heart was placed. Again, here is the abnormal film and a comparison normal film.



When I’ve shown the abnormal film to medical students, they usually know that something is amiss, but they can’t quite put their finger on what’s wrong.

Many med students learning introductory radiology find it much harder to recognize the absence of a normal structure than to recognize the presence of an abnormal structure. Or as one of my former professors used to put it, “The hardest thing to see is something that isn’t there.”

This principle is not unique to medicine, of course. For instance, the “dog that didn’t bark” (when it should have) was the key to a Sherlock Holmes mystery story.

And part of radiology residency training is to develop the appropriate mental checklists so that when one analyzing any radiology exam (ranging from a chest x-ray to a brain MRI scan), one is methodically looking both for “things that should be here but aren’t” as well as “things that shouldn’t be there but are”.

A few comments on some secondary findings:

The lungs are “dirtier” than usual (i.e., with more white), because of fluid build-up from his prior congestive heart failure. There are also various life-support lines and tubes that project over different portions of his chest. The dark vertical stripe in the midline is the incision used to remove the heart.

Today’s X-Ray

 Posted by on 17 February 2009 at 1:00 pm  Fun, Health Care
Feb 172009

Today’s x-ray is from a 55-year old man. The film was taken in the operating room (“OR 3″). Notice anything interesting?

(Answer tomorrow.)

A Comment on the FIRM Blog

 Posted by on 17 February 2009 at 12:01 am  Health Care
Feb 172009

I’m totally floored by this recent comment to We Stand FIRM. It was posted in response to an op-ed debunking the myth of administrative savings under “single payer” systems of government heath care. Read it and weep:

the Canadian healthcare system is not the best in the world and certainly not perfect. however it is still rated superior to the system (or lack of a system) we have here in the US by the WHO. call it “socialist medicine” if you like, but like chairmen deng once said, “no matter it’s a white cat or a black cat, as long as it can catch mice, it’s a good cat.” lol.

the Canadian system is only at the 30th place in world ranking. how about looking at the other 29 better models? again, no single system in this world is absolutely perfect, but instead of picking faults (and i’m sure the canadians are going to have a grand time picking the faults of the american system, too), how about learning from their pros and cons and try to find the best system that works uniquely for the US? how about stop advertising your own personal beliefs and incentives, stop quoting our funding fathers who, though undoubtedly very wise in their time, could not possibly have foreseen the social condition and issues we are facing at present day? how about instead of dismissing new ideas regardless good or bad, try to focus on improving the efficiency of the government and fighting bureacracy, which is the primary reason why the many government programs didn’t work, not the initiative itself?

the theory that lasses-faire or free market mechanism will improve the US healthcare system (or the lack of a system) without external (government) interference – has this been proven anywhere by any means? a lot of americans focus so much on individual rights and benefits, which is based solely on their “beliefs” without any scientific or socioeconomic justification. they have very little regard to the well-being of the group, the society and the nation as a whole. and they think by defending the (implied) meaning of the constitution, they’re displaying such remarkable patiotism. honestly, i do not care what you believe, or what you think it right and morally acceptable. in fact, what i “believe” in completely irrelevant, too. what we should try to achieve, as a whole, is commonwealth and stability of our society, which will in turn benefit each and every individual within. what do you think is the priority of the government: defending YOUR personal ideals and beliefs, which is a lot of times the source of misinformaiton, conflicts, and chaos, or promoting the well-being of the society?

It would simply take too much time to comment on all that is wrong with that, so I invite you to pick your favorite bit of inanity to fisk in the comments.

X-Ray Answer

 Posted by on 13 February 2009 at 12:33 pm  Fun, Health Care
Feb 132009

This woman has a completely collapsed left lung. That’s why the left chest cavity is completely black. In contrast, the still-normal right lung shows the fine branching blood vessels emanating from the heart.

The white glob of tissue adjacent to the left side of her heart is her collapsed left lung plastered up against the left-sided heart border.

Here is a normal chest x-ray for comparison:

This is a severe case of spontaneous pneumothorax, much more severe than this one from three months ago.

The last I had heard, she was appropriately treated and doing well.

The slight difference in the height of the two sides of her diaphragm are within normal variation.

The apparent scoliosis of the spine is not real. Instead, I think folks are looking at the air-filled trachea (windpipe) which takes a slight normal curve to the right as it moves past the aorta. The trachea is slightly darker vertical stripe which then branches into the two separate “mainstem bronchi” — one for each lung.

Today’s X-Ray Case

 Posted by on 12 February 2009 at 12:27 pm  Fun, Health Care
Feb 122009

Another walk-in case from our routine practice: 30-year old woman with chest pain and shortness of breath. (Click on image to see it full-size.)

As usual, her left side is on the image right (marked with the “L”). Her right side is on the image left.

Answer tomorrow.

MRI Case Answer

 Posted by on 28 January 2009 at 1:48 pm  Fun, Health Care
Jan 282009

Once again, here is the original image:

Here is a magnified view of the abnormality, at the front of the knee just below the patella (kneecap):

The patellar tendon is torn. It should be a smooth black stripe, as in the normal image:

The patellar tendon is normally very strong. In fact, you can feel how stout your own patellar tendon is by placing your finger just below your kneecap while your knee is extended, then gently bending your knee back and forth a few degrees (i.e., 2-3 inches).

Hence, patellar tendon ruptures are fairly rare sports injuries. Here’s more information.

Some of the other guesses were reasonable. However, I only gave one image (out of over 100), so many of the other structures of the knee were not included. For instance, the cruciate ligaments were not fully included on this one image and they happenened to be intact. But one would have required seeing the full data set to know one way or another. There probably was also some hemorrhage in the skin and fat just anterior to (in front of) the patellar tendon tear.

If you enjoy these semi-regular radiology case presentations, please let me know. My practice is very busy, so it’s easy for me to find and post interesting case examples to NoodleFood.

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