Little Old Lady

Hetty Vord's (72) golf handicap has recently deteriorated. She has noticed that her swing has changed: in order not to hit the ground she must grab the club a little lower. The pain in her back has also increased. Her 27-year-old grandson—a psychiatrist in training—has told her that she is shrinking. She told him to mind his own business and to stop growing himself. It is because of her pain that she has now come for a radiograph of the lumbar spine. Paul and Ajay look at the radiograph together (Fig. 8.23).

I The Case of Hetty Vord

Fig. 8.22 An extensive osteolytic focus is seen in the diaphysis of the radius of this patient with hyperparathyroidism.

The more consequential a diagnosis is for the patient, the more carefully must the breaking of the news to the patient be prepared. It is generally the referring physician who knows the patient best and who should cautiously inform, explain, and support. A mature and responsible patient must, however, also be treated as such by the radiologist.

I The Case of Hetty Vord

Girdle Wearers
Fig. 8.23 Can you call the diagnosis on the basis of these lumbar spine films of Mrs. Vord?
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