BMJ Case Reports 2018; doi:10.1136/bcr-2017-223166
  • Learning from errors

Spinal meningioma, aortic aneurysms and the missing link of observation: the anchoring heuristic approach

  1. Alexander Oberhuber1
  1. 1Vascular and Endovascular Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
  2. 2Plastic, Reconstructive and Hand Surgery, HELIOS Universitatsklinikum Wuppertal, Wuppertal, Germany
  1. Correspondence to Dr Marios Papadakis, marios_papadakis{at}
  • Accepted 22 February 2018
  • Published 10 March 2018


Over the last three decades, the development of systematic and protocol-based algorithms, and advances in available diagnostic tests have become the indispensable parts of practising medicine. Naturally, despite the implementation of meticulous protocols involving diagnostic tests or even trials of empirical therapies, the cause of one’s symptoms may still not be obvious. We herein report a case of chronic back pain, which took about 5 years to get accurately diagnosed. The case challenges the diagnostic assumptions and sets ground of discussion for the diagnostic reasoning pitfalls and heuristic biases that mislead the caring physicians and cost years of low quality of life to our patient. This case serves as an example of how anchoring heuristics can interfere in the diagnostic process of a complex and rare entity when combined with a concurrent potentially life-threatening condition.


  • Contributors NF: study conception, data collection, literature search and manuscript drafting. MP: data collection, literature search and manuscript drafting. HS: data collection and literature search. AO: study conception, data collection and literature search. All authors revised the manuscript critically for important intellectual content and approved the version submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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