Incidentaloma

16 Aug

FOOD FOR THOUGHT:

review of 3113 patients with trauma abdominal CTs in the ED

Interesting numbers:

  • 1103/3113 (~35%) patients with incidental findings.
  • 75% of patients with incidental lesions had no traumatic findings.
  • Benign anatomic variants were present in 1.8%,
  • benign pathologic findings in 27.5%,
  • pathologic findings requiring work-up in 6.1%.

Congenital renal anomalies and duplicate inferior vena cava were the most common benign anatomical findings.

Renal and hepatic cysts were the most frequent benign lesions

non-calcified pulmonary nodules and adrenal masses were the pathologic lesions most commonly seen.

The article concludes that appropriate protocols for further evaluation and follow-up should be incorporated into Trauma CT scans.

——–

Another review of 321 ED renal stone CT abdomens

interesting numbers:

  • incidental findings in 45% of scans ( ~half were rated of “moderate” or “serious” concern)
  • only 21% of incidental findings were documented
  • only 18% (11 cases) of moderate/severe incidental findings had evidence of follow-up on chart review

study conclusion:

“Although work-up of these 11 cases did not yield any serious diagnoses, many potentially serious incidental findings without follow-up remain worrisome.”

BOTTOM LINE:

more frequent CTs mean likely more incidental findings unrelated to the acute issue

incidentaloma’s found in 35-45% in these two studies (wow)

smaller but not insignificant percentage need follow-up work-ups: make sure the patient knows, and has a plan for follow-up

Submitted by C. Stokes.

References: Ekah AP, et al. The Prevalence of Incidental Findings on Abdominal Computed Tomography Scans of Trauma Patients. The Journal of Emergency Medicine. 2010; 38:4;484-489Messersmith WA, Brown DFM, Barry MJ. The Prevalence of Implications of Incidental Findings on ED abdominal CT Scans. American Journal of Emergency Medicine. 2001; 19:6 ; 479-481; picture

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