Appreciate How Far We've Come

“Twice-daily doses of mercury, boiled milk and lime water along with a carrot poultic.”  Doctors prescribed this therapy to a 30-year-old patient admitted to Mass General Hospital (MGH) in 1821.  The patient, a saddler, suffered from secondary syphilis.  Eight months after languishing in the hospital the patient died, likely succumbing to mercury poisoning.  At that time, medical diagnosis was rudimentary and physicians relied heavily on clues given to them by the patient upon presentation.  In fact, physicians typically rendered a final diagnosis retrospectively following the discharge or death of the patient.

The above case presentation is featured as part of an exhibit detailing the first 100 cases treated at MGH.  The exhibit was unveiled during the hospital’s bicentennial celebration and can be accessed online. (http://www.massgeneral.org/about/newsarticle.aspx?id=2598).

I took call on the night of February 25th of this year, which also happened to be the 200th anniversary of the signing of the MGH charter. Things sure have changed.  As I sat at the PACS station interpreting multiple routine cancer follow-up CT and MRI scans, I was paged by my division chief and asked to accompany him to the OR for an interoperative ultrasound scan requested by one our hospital’s transplant surgeons.

We entered the OR donning sterile gowns and gloves and toting a portable ultrasound machine.  Mr. Jones, 56, had recently received a living donor renal transplant from his daughter.  His nephrologists noted that his kidney function was deteriorating and was concerned the patient may have thrombosed a feeding vessel as his transplant had been performed only a week prior.  

By the time we arrived to the OR, the surgeon had dissected down to the level of the transplant kidney in the right lower quadrant and the capsule of the kidney glistened in the harsh focused light of the OR.  I placed the ultrasound probe directly on the kidney and detected adequate blood perfusion using Doppler interrogation.  However, sluggish flow was noted to the upper pole of the kidney.  Further evaluation revealed a hematoma compressing the upper pole.  After this collection was adequately drained, the surgeon closed the patient and follow-up scans revealed the transplant kidney was functioning normally.  Mr. Jones now enjoys his new life free from the burdens of weekly dialysis.  

Medical imaging has been called by Sir Keith Peters, President of the Academy of Medical Sciences, “the most important advance in diagnostics in the twentieth century.”

Our ability to assist the surgeons and nephrologists in Mr. Jones’ case was truly remarkable when compared to the diagnostic tools available to physicians 200 years ago.  Imaging now allows for improved accuracy and timeliness of diagnosis with a concomitant reduction in invasive procedures. 

Due to advances in medicine, surgery, and diagnostics, Mr. Jones will now have the chance to live out a near normal life which he would not have been able to do 200 years ago and, perhaps, not even 30 years ago.  Propelled by newer imaging modalities such as molecular and functional imaging, the future of advanced diagnostics only looks brighter.

Dr. Krishnaraj is a clinical fellow in the Abdominal Imaging and Intervention division, Department of Radiology, at Massachusetts General Hospital/Harvard Medical School. He can be reached at akrishnaraj@partners.org.