How a fellow physician helped solve a mystery

Sarv Priya, MBBS, speaks from experience when he talks about the importance of sharing ideas without fear of stepping on someone else’s toes.

He’ll never forget the CT image that changed an 8-year-old’s life. This case also changed his perspective on patient care.

“By working together, we shed boundaries,” says Priya, who completed his first residency in New Delhi and a cardiovascular imaging fellowship in Boston before coming to Iowa City. “This case motivated me further to being open to all dialogues and discussions with colleagues in different specialties.”

A rare disorder

While training as a fellow in pediatric radiology at University of Iowa Hospitals & Clinics, Priya looked at a new CT image of a child who had been dealing with low oxygen levels for years and was receiving treatment for asthma.

He observed that the 8-year-old had a congenital heart abnormality called a left superior vena cava. That caused him to wonder: Does the child have a rare drainage defect in the heart? If so, does that mean the child should be further evaluated for a potential right to left shunt that can explain low oxygen levels instead of asthma?

When he looked further into the patient’s chart, he realized that despite multiple follow-up visits, this rare diagnosis had not been considered. With some hesitancy, Priya brought the idea to the attention of the referring doctor and the cardiology team. They listened to his concern, and a repeat echocardiogram was performed to specifically look at the left superior vena cava to see if it was draining abnormally into the left side of the heart.

“The test confirmed Priya’s suspicions,” says Yutaka Sato, MD, PhD, professor of radiology. “He saved the child from many more years of treatment for presumed asthma.”

Open dialogue

Priya’s willingness to speak up highlights how important it is to share concerns or ideas because it ultimately can improve patient safety and health.

Now, every time Priya sees an unexpected or critical finding in imaging, he talks with colleagues without hesitancy.

“In the end, it’s not about me; it’s about the patient’s health,” he says. “This one case is etched into my mind because it ended up improving a child’s quality of life. It takes a collective effort from diagnosis to treatment for high quality care.”


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