SHM Converge Scientific Abstract ePoster Gallery-A Curious Case of Covid?

Pdf Summary

This case report describes a 92-year-old woman in Mass General Brigham’s Home Hospital program who initially presented to the ED with headache, cough, congestion, hypoxia, and right upper quadrant (RUQ) pain. Early testing showed a positive COVID-19 PCR and pyuria on urinalysis, so she was admitted and treated for COVID and a presumed UTI. Initial imaging was unrevealing except for a large simple right hepatic cyst.<br /><br />Despite treatment, she later developed persistent fevers, E. coli bacteremia, elevated liver function tests, and ongoing lethargy and leukocytosis. Additional workup revealed aortic valve vegetation on transthoracic echocardiogram and, on repeat CT abdomen/pelvis, an enlarging right hepatic lobe collection with rim enhancement consistent with a liver abscess. She underwent interventional radiology drainage and was continued on IV ertapenem.<br /><br />The presentation emphasizes diagnostic reasoning and the role of cognitive bias in missed diagnoses. The authors highlight availability bias, where common/recent diagnoses like COVID or UTI may be overweighted, and search satisfying, where clinicians stop investigating after finding a plausible explanation. In this case, RUQ pain was attributed to more familiar causes, delaying recognition of a rare hepatic abscess.<br /><br />The report also underscores the importance of continuity of care and in-person examination in Home Hospital settings, where ongoing reassessment can reveal evolving pathology that may not be apparent on initial evaluation.<br /><br />Learning objectives include recognizing cognitive bias in diagnostic errors and appreciating the value of continuity and physical examination in home-based inpatient care.

Asset Subtitle

Victoria Sinyak

Meta Tag

Author List Allison Ruhe, Victoria Sinyak

Category Clinical Vignettes

Concept Diagnostic Error

Concept Differential Diagnosis

Concept Availability Bias

Concept Search Satisfying

Concept Continuity of Care

Distinguished Non-Finalist

Presenter Organization MGB Home Hospital

Presenting Author Victoria Sinyak

Track Adult

Keywords

COVID-19

urinary tract infection

liver abscess

E. coli bacteremia

aortic valve vegetation

diagnostic reasoning

availability bias

search satisfying

Home Hospital

interventional radiology drainage

Diagnostic Error

Differential Diagnosis

Availability Bias

Search Satisfying

Continuity of Care