Birds migrate. People migrate. The human placenta migrates from lower uterine segment to upper uterine segment sometimes. But more about it some other time. This one is about migrating location of uterine leiomyomas.
That patient came to our outpatient clinic with about 9 cm diameter leiomyoma in the vagina. Since we could not reach the upper part of the leiomyoma, we could not see where the cervix was. She had an ultrasonographic report from an outside clinic showing that it was a central cervical leiomyoma arising from the anterior wall, stretching the posterior cervical wall over it. It did not disclose the location of the external os. Our people are intensely loyal to our institute. So they got a scan done by our sonographers. Their report came as a central cervical leiomyoma arising from the posterior wall, stretching the anterior cervical wall over it.
"Sir, the reports are exactly opposite of each other" my Registrar said.
"Could the origin of the leiomyoma have migrated between the two scans?" someone sniggered.
"I would tend to believe the first report, because it is done by a qualified sonologist, with some experience in private practice. The second report is by a resident doctor in training. We also have enough experience of our local people, who sometimes give mirror image locations of structures instead of their actual locations. We have to explore and remove the mass anyway, no matter where it is coming from. So relax. We will know about its location on our OT day."
It turned out to be neither. It was a polyp arising by a short pedicle from the posterior endocervix 0.5 cm above the external os. No part of the cervical canal was stretched over it."
"Our people were more right than the qualified private practitioner, though both were wrong" said someone. "How do we explain that?"
I was stumped.
"The only explanation is that he must have been one of our local people, now qualified and in private practice" someone said. Everybody laughed.
I knew it was not right to laugh. I also knew there was something that needed to be set right. But I could not do it because I was not a sonographer and did not know how.
That patient came to our outpatient clinic with about 9 cm diameter leiomyoma in the vagina. Since we could not reach the upper part of the leiomyoma, we could not see where the cervix was. She had an ultrasonographic report from an outside clinic showing that it was a central cervical leiomyoma arising from the anterior wall, stretching the posterior cervical wall over it. It did not disclose the location of the external os. Our people are intensely loyal to our institute. So they got a scan done by our sonographers. Their report came as a central cervical leiomyoma arising from the posterior wall, stretching the anterior cervical wall over it.
"Sir, the reports are exactly opposite of each other" my Registrar said.
"Could the origin of the leiomyoma have migrated between the two scans?" someone sniggered.
"I would tend to believe the first report, because it is done by a qualified sonologist, with some experience in private practice. The second report is by a resident doctor in training. We also have enough experience of our local people, who sometimes give mirror image locations of structures instead of their actual locations. We have to explore and remove the mass anyway, no matter where it is coming from. So relax. We will know about its location on our OT day."
It turned out to be neither. It was a polyp arising by a short pedicle from the posterior endocervix 0.5 cm above the external os. No part of the cervical canal was stretched over it."
"Our people were more right than the qualified private practitioner, though both were wrong" said someone. "How do we explain that?"
I was stumped.
"The only explanation is that he must have been one of our local people, now qualified and in private practice" someone said. Everybody laughed.
I knew it was not right to laugh. I also knew there was something that needed to be set right. But I could not do it because I was not a sonographer and did not know how.
