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What the Heck is an Aunt Minnie?

Do you have an Aunt Minnie? If you are a medical imaging professional or even a student of one of the disciplines you may have several or a whole bunch of Aunt Minnies.

Aunt Minnie

What is an ‘Aunt Minnie’?

Grammar buffs may be thinking, “Don’t you mean who is Aunt Minnie?”

But we’re not talking about your mom or dad’s sister. We’re talking about a popular term in radiology circles that has been extended to other medical imaging specialties as well.

Radiologists Dr. Ed Neuhauser and Dr. Ben Felson have each been credited as coining the term. (According to Radiopaedia.org, Neuhauser created the expression and Felson popularized it.)

“Aunt Minnie” as “a case with radiologic findings so specific and compelling that no realistic differential diagnosis exists. In other words: If it looks like your Aunt Minnie, then it’s your Aunt Minnie.”

AuntMinnie.com is an online forum and resource for radiologists and other medical imaging professionals to collaborate and to share research and news. It was founded by a radiologist named Dr. Philip Berman in 1999 who felt the term “Aunt Minnie” was the ideal for the name of his website.

AuntMinnie.com says that Dr. Felson defined “Aunt Minnie” as “a case with radiologic findings so specific and compelling that no realistic differential diagnosis exists. In other words: If it looks like your Aunt Minnie, then it’s your Aunt Minnie.”

Think running into your Aunt at a family reunion. You may not see her every day, but once you see her, you know it’s her.

AuntMinnie.com contributor, Dr. Jason Birnholz wrote in his March 2012 “The Practice of Ultrasound: Part 5” article, “As I recall, [Ben Felson] often said that when your Aunt Minnie enters the room, you know right away who she is, even if you don’t know how you know. He meant this as a metaphor for learning to recognize some specific patterns of pathology (mainly in chest films) instantly and preconsciously.”

In his book Radiology 101: The Basics & Fundamentals of Imaging, author Wilbur L. Smith elaborates by saying, “The term Aunt Minnie, coined by the late Dr. Ben Felson, refers to the unmistakable and unforgettable appearance of your Aunt Minnie, or Uncle Al, or any other family character. A radiologic Aunt Minnie describes an image appearance so classic that, once you see it, you never forget it.”

Examples of Aunt Minnies

Kimberly E. Applegate, MD, and Duncan V.B. Neuhauser, PhD, cited a popular “Aunt Minnie” example in an April 1999 issue of Radiology magazine. Some time in the mid 90s or so, at Boston Children’s Hospital, a pediatrician showed a radiologist a series of skeletal X-rays taken of a young child. It was thought the child had been battered. The radiologist looked at the images and declared the child had leukemia. “Startled, the clinician protested that the complete blood cell count was normal,” wrote Applegate and Neuhauser. “The radiologist replied, ‘What can I say? It’s an Aunt Minnie!’ Several weeks later, a repeat complete blood cell count was abnormal and the child was symptomatic with leukemia.”

Dr. Birnholz, who has been writing a series of “Practice of Ultrasound” articles for AuntMinnie.com, shared his “Aunt Minnie” finding in his March 30, 2012 piece. “Soft, well-demarcated reflective nodules in subcutaneous fat are an Aunt Minnie of a sign,” he wrote. He described them further as “…clinically occult, echogenic tumorlike collections of mast cells in subcutaneous fat, detected by superficial scanning with a high-frequency, low-noise ultrasound imaging system…”—that these were signs for “systemic mast cell disease.”

Aunt Minnie Publications

The fourth edition of Aunt Minnie’s Atlas and Imaging-Specific Diagnosis edited by Thomas L. Pope came out last year. It is thought to be maybe the largest “collection of Aunt Minnie-like” cases,” featuring over 1,000 images complimenting descriptions of classic cases organized into numerous chapters from ultrasound and nuclear medicine to gastrointestinal radiology, breast imaging and neuroradiology.

In his Radiology 101 book, author Smith presents some images of common cases, like of gallstones or pills inside the GI tract. With confirmed Aunt Minnies, he recommends “[filing] them away in your visual-cerebral computer, and your ability to recognize them will make you a star in the eyes of your colleagues, teachers, and patients.”

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