Q&A: Keep asking questions if test results don’t make sense

Q. My son had an X-ray of his knee a few weeks ago following an injury. It did not show a fracture, however, the radiologist did notice a thin linear sclerosis in the medial femoral condyle. He thought it might be due to an old injury, which my son never had. Do you have any thoughts as to what this might be and if I should pursue this further?

A. X-rays capture a moment in time and can be interpreted in many different ways. Different radiologists use slightly different terminology for describing their findings. So, it would be difficult to give you a specific diagnosis for your son based off this xray report alone. What I can offer, however, is a bit of insight into the world of diagnostic tests in children to give you a framework for evaluating how best to pursue a test result in general for your kids.

X-Rays are black/white/and gray representations of our bones and surrounding tissues. They are really shadows and not true pictures. “Reading” an X-Ray is like figuring out what a shadow in a dark room may be from. These shadows can mean different things to different doctors and comparing the shadows to what we see in the patient is crucial to making a diagnosis from an X-Ray.

The X-Ray report is only one small piece of figuring out what may be wrong with a patient, such as when an injury occurs. The patient’s physical exam and medical history are really the key players in helping us sort out what may be going on. This clinical information is also very useful to the radiologist and really helps guide the final interpretation of the study.

Tests in general only capture a moment in time. Some tests run on machines, some use chemical agents, and all involve people setting up the tests, reading the results and interpreting the results. Some tests result in a number and others in images that need to be interpreted for us. A “normal” study does not mean there is not a problem; likewise, a “finding” may not have clinical significance for that patient. In the end, it is the patient and their exam that will guide us to the next steps.

So, for any test your child has, ask questions until you feel comfortable with the result and its meaning. If a test results comes back as “normal” and your child has symptoms that are concerning to you, ask questions and formulate a plan with your child’s doctor to monitor and reevaluate the situation. “Normal” in the world of tests does not mean “nothing” is occurring – it just means that the test does not detect anything specific.

Finally, keep in mind that any test is something that is done to your child and can be frightening. Explain the test to your child and be honest about what will occur, even if it will hurt. Ask when the results will be back and be sure you get those results directly from your doctor’s office. We are the ultimate advocates for our children so with any test result or X-ray report, feel free to be politely persistent about tracking down the results and understanding their meaning. Ultimately, your pediatrician knows you and your child the best and can help you pursue the right options for your child.

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