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Diagnosis Mistake Leads to Removal of Infant’s Healthy Kidney | Port Orange Personal Injury Lawyer

Diagnosis Mistake Leads to Removal of Infant’s Healthy Kidney

A five-month-old infant underwent the surgical removal of her right kidney after she was diagnosed with a cancerous tumor.

That procedure turned out to be unnecessary because the pathological results of the kidney examination revealed only an infection that was responding to antibiotics. This mistake is now something that the child will have to live with for the rest of her life.

The five-month-old girl was referred to the emergency department for evaluation of intermittent fevers (103.8) and lethargy. On physical examination, she had a rectal temperature of 99.8, pulse 129 and respiratory rate 40. Her chest was clear and the abdominal exam was unremarkable.

The infant was admitted for fever workup with laboratory studies suggestive of a urinary tract infection and possible pyelonephritis or kidney infection. The urine culture grew out E coli and the infant was started on intravenous Ampicillin and Gentamycin.

A renal ultrasound was ordered to rule out hydronephrosis, the dilation of the kidney collecting system. During the night, the child spiked a temperature of 102 and was given Tylenol with good effect.

At 9 a.m. the next day, the renal ultrasound revealed a 2×2 cm mass in the upper pole of her right kidney. According to the radiologist, the location and appearance of the lesion — as well as the age of the patient — made it suspicious for a Wilms’ tumor or cancer of the kidney. A progress note written by a pediatric resident listed the primary diagnosis as “UTI/pyelonephritis and renal mass.”

The attending pediatrician reviewed the abdominal CT scan with the radiologist and confirmed the finding of a right renal intraparenchymal mass, and no clear adenopathy or swelling of the lymph nodes (a chest CT scan was negative). The differential diagnoses remained Wilms’ tumor, possible mesoblastic nephroma. The plan was to continue antibiotics and obtain a surgery consult for a right nephrectomy.

Later in the day, the pediatric surgeon evaluated the infant and his differential diagnoses included a small Wilms’ tumor and a mesoblastic nephroma. The parents were told that their daughter had a Wilm’s tumor, and they consented to a surgery. This was scheduled the next day for either a heminephrectomy – partial removal of the kidney – or a complete nephrectomy, complete removal of the kidney.

At 8 p.m., repeat urinalysis was clear with specific gravity of 1.014, no red blood cells, 0-2 white blood cells, and few bacteria. The white blood cell count was 11.2 and the infant was afebrile (no longer feverish).

The next morning, the patient was taken to the operating room for a possible nephrectomy. According to the operative report, “the right kidney was palpated and had only a subtle enlargement near the upper pole anteriorly just above the mid-portion. After the kidney was mobilized, once again it was palpated and there was no definitive mass that could be felt.”

Despite those findings, the kidney was removed and sent off for frozen section. The patient’s pain was well controlled and her temperature was at normal levels during the postoperative period.

According to the final pathology report, the right kidney had acute and chronic pyelonephritis (acute lobar nephronia, severe with perinephrenic fat extension). This kidney lesion is commonly associated with reflux infection of E. coli which was cultured in the urine of this patient. There was no evidence of malignancy.

The parents had mixed feelings: they were relieved that there was no malignancy but angered that their daughter’s kidney was removed unnecessarily. The family sued the pediatrician, the radiologist, and the pediatric surgeon, alleging the “needless loss” of their infant daughter’s right kidney. The case was settled against the radiologist for close to $1 million.

Factors in this case that led to a successful medical malpractice settlement include:

Too narrow of a focus. Once the changes in the kidney were thought to represent a tumor, the possibility of a kidney infection was no longer considered. Doctors focused solely on cancerous diagnoses and made the decision to operate based on that diagnostic focus.

Symptoms and lab results that don’t line up with a favored diagnosis, as was the case here, can be a flag to reassess.

Lack of communication. Operating room communication can identify potential errors before they harm the patient. Despite two failed attempts to feel the suspected tumor in the young child’s kidney, the surgeon opted to proceed with removal of the kidney.

Lack of documentation. The young patient’s chart lacked documentation of communication among doctors to support the decision to remove a kidney and did not include any discussion with the parents of alternative diagnoses or treatment options.
A brief note, with date and time, needs to include some reference to the differential diagnosis, deliberation between specialists, and discussion with patients or families about options. A major procedure with potentially life-altering consequences should be a flag for extra attention to documentation.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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