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At least 19 recordsLinked to original sources
PubMed2005

Incidental findings computed tomography of the thorax.

Numerous findings incidental to the stated indication for obtaining a computed tomogram (CT) of the chest are encountered. While some findings are life threatening (eg, pulmonary embolism), others are clearly benign (pulmonary hamartoma, vertebral hemangioma). This article discusses management issues related to the detection of unexpected findings in different compartments of the thorax. In the future, more detailed outcome data will be available to better guide medical decision-making.

Cardiovascular Diseases↗
PubMed2006

Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings.

The objective of the present study is to determine the feasibility of chest computed tomography (CT) in screening for lung cancer among asbestos-exposed workers. In total, 633 workers were included in the present study and were examined with chest radiography and high-resolution CT (HRCT). A total of 180 current and ex-smokers (cessation within the previous 10 yrs) were also screened with spiral CT. Noncalcified lung nodules were considered positive findings. The incidental CT findings not related to asbestos exposure were registered and further examined when needed. Noncalcified lung nodules were detected in 86 workers. Five histologically confirmed lung cancers were found. Only one of the five cancers was also detected by plain chest radiography and three were from the group of patients with a pre-estimated lower cancer probability. Two lung cancers were stage Ia and were radically operated. In total, 277 individuals presented 343 incidental findings of which 46 required further examination. Four of these were regarded as clinically important. In conclusion, computed tomography and high-resolution computed tomography proved to be superior to plain radiography in detecting lung cancer in asbestos-exposed workers with many confounding chest findings. The numerous incidental findings are a major concern for future screenings, which should be considered for asbestos-exposed ex-smokers and current smokers.

Aged↗
PubMed2001

The prevalence and implications of incidental findings on ED abdominal CT scans.

We reviewed reports from 321 consecutive emergency department (ED) noncontrast, helical "renal stone" abdominal CT scans obtained at a single medical center between April 1996 to June 1997 for incidental findings. Incidental findings were common (45% of scans), and approximately half were rated of "moderate" or "serious" concern by 2 independent reviewers (kappa = 0.72). ED records indicated that only 21% of incidental findings were documented, and only 11 (18%) of cases with findings of "moderate/severe" concern had evidence of follow-up on hospital chart review. Although work-up of these 11 cases did not yield any serious diagnoses, many potentially serious incidental findings without follow-up remain worrisome.

Abdomen↗
PubMed1989

Cavernous hemangioma of the incus (an incidental finding).

The incidental discovery of a cavernous hemangioma in an apparently normal incus found during pathological examination is reported. The incus had been removed during the course of a total osseous labyrinthectomy for delayed endolymphatic hydrops (DEH), and this unexpected finding noted. Although rare, hemangiomatous involvement of the temporal bone does occur and its manifestations are discussed. To date there have been no other reports of a hemangioma involving the incus solely.

Adult↗
PubMedDate not supplied

PACS: effect on incidental findings.

Previous studies have addressed the increased volume of incidental findings when interpreting MRI lumbar spine studies after the implementation of a picture archiving and communication system (PACS). The purpose of this study is to confirm prior findings and contribute additional knowledge that supports the use of technology in complimenting the quality of patient care. Lumbar spine interpretations were reprinted from 900 studies and individually reviewed. These lumbar spine studies were performed on a 1.5-tesla magnet. Included were 300 consecutive lumbar spine reports over a two year period: four months prior to PACS introduction, four months during the transition to PACS, and four months post PACS implementation. Reports stating incidental findings were tabulated, along with the frequency patient gender, age, location (outpatient, inpatient or emergency room), reporting radiologist, specific finding and radiologist recommendations in each case were documented. The number of incidental findings increased from five pre-PACS to nine during the transition phase to PACS, followed by 11 post-PACS. This results in a maximum increase of 120 percent from pre- to post-PACS. The most common incidental findings include renal mass, cyst or lesions, aortic aneurysms and lymph node abnormalities. Statistical data confirms that the implementation of PACS into a radiology practice for MRI lumbar spine imaging appears to have a beneficial impact on the number of reported incidental findings and recommended follow-up studies.

Adolescent↗
PubMed2004

Discovery and disclosure of incidental findings in neuroimaging research.

PURPOSE: To examine different protocols for handling incidental findings on brain research MRIs, and provide a platform for establishing formal discussions of related ethical and policy issues. MATERIALS AND METHODS: Corresponding authors identified from a database of peer-reviewed publications in 1991-2002 involving functional MRI (fMRI), alone or in combination with other imaging modalities, were invited to participate in this web-based survey. The survey asked questions regarding knowledge and handling of incidental findings, as well as characteristics of the scanning environment, training required, IRB protocol requirements, and neuroradiologist involvement. RESULTS: Seventy-four investigators who conduct MRI studies in the United States and abroad responded. Eighty-two percent (54/66) reported discovering incidental findings in their studies, such as arteriovenous malformations, brain tumors, and developmental abnormalities. Substantial variability was found in the procedures for handling and communicating findings to subjects, neuroradiologist involvement, personnel permitted to operate equipment, and training. CONCLUSION: Guidelines for minimum and optimum standards for detecting and communicating incidental findings on brain MRI research are needed.

Biomedical Research↗
PubMed2002

Picture archiving and communication system: effect on reporting of incidental findings.

PURPOSE: To determine the effect of a picture archiving and communication system (PACS) on reporting of incidental findings outside the area of interest, with a focus on lumbar spinal magnetic resonance (MR) imaging. MATERIALS AND METHODS: Results of 2,500 lumbar spinal 1.5-T MR examinations were reviewed. These included 500 consecutive lumbar spinal MR reports for each of 5 years: 1 year prior to PACS introduction, 1 year during transition to PACS, and 3 consecutive years thereafter. Incidental findings cited in the reports were tabulated, and the frequency, organ system involved, and radiologist recommendations in each case were noted and compared, as were projected expenses based on the Medicare payment scale for recommended follow-up studies. Results of available follow-up studies were also reviewed. RESULTS: The number of incidental findings increased from 19 before PACS to 31 during transition and 53, 49, and 50 after PACS implementation, which resulted in a maximum increase of 179%. The increase was statistically significant during each post-PACS year. The most common incidental findings involved potential renal, pelvic, hepatic, pulmonary, and lymph node abnormalities. The total number of recommended follow-up studies increased from five before PACS to 15 during transition and 32, 22, and 18 after PACS implementation, with a maximum increase of as much as 540%. Recommended ultrasonographic studies increased the most from two in the pre-PACS year to 11 during transition and 27, 17, and 14 in the 3 post-PACS years. Follow-up expense increased by a mean of 146% after PACS implementation from 4,221 dollars per 1,000 studies in the pre-PACS year to 9,307 dollars, 13,426 dollars, 10,558 dollars, and 8,252 dollars thereafter. Of the 202 incidental findings, four represented occult malignancy, which is an expense of 5,721 dollars per diagnosis. CONCLUSION: The introduction of PACS into radiology practice for lumbar spinal MR imaging appears to be associated with an increased number of reported incidental findings and recommended follow-up studies.

Adolescent↗
PubMed1998

Feasibility of "limited" echo imaging: characterization of incidental findings.

To evaluate the feasibility of limiting the extent of the echocardiographic examination without omitting significant incidental findings, we reviewed consecutive reports from full echo studies performed in a tertiary medical center with the following referral questions: "rule-out pericardial effusion" (n = 40) and "rule-out source of embolus" (n = 132). Specific limited echo imaging protocols were formulated without unnecessary imaging (that is, unrelated to the diagnostic question) or use of Doppler. The percentage of full echo studies with significant incidental findings was determined, categorized by patient age, and then recalculated by whether the specific limited imaging protocol could potentially detect any or all of the incidental findings. The percentage of cases with significant incidental findings was 45% and 36% in the "rule-out" pericardial effusion and source of embolus groups, respectively. This percentage was dependent on age <65 years versus > or =65 years (22% vs 42%, p < 0.005). Limited imaging protocols could identify > or =85% of cases with significant incidental findings. These data suggest that limited echo imaging may be feasible in certain patient groups and referral diagnoses.

Adult↗
PubMed2003

Incidental findings of thickening luminal gastrointestinal organs on computed tomography: an absolute indication for endoscopy.

OBJECTIVES: Incidental findings of thickened luminal GI organs (LGIO) on CT are not uncommon. However, the significance of these findings is unclear. Because of the lack of scientific data, there are no clinical guidelines for the evaluation of these radiologic abnormalities. Our objective was to determine whether endoscopic evaluation of these findings revealed significant abnormalities. METHODS: This study evaluated all incidental findings of thickened LGIO in a large medical center from October, 1997 to March, 1999 that were followed by endoscopic examinations. RESULTS: Ninety-six percent of patients with incidental findings of thickening of the sigmoid colon or rectum, 81% of patients with thickening of the distal esophagus, and 13% of patients with thickening of the cecum had significant abnormalities on further endoscopic work up. CONCLUSIONS: Although positive pathologic findings are less common in thickening of the cecum than in other LGIO, all of these incidental findings on CT warrant further endoscopic examination.

Adult↗
PubMed2004

Ethical consideration of incidental findings on adult brain MRI in research.

OBJECTIVE: To characterize the frequency and severity of incidental findings in brain MRIs of young and older adult research volunteers, and to provide an evaluation of the ethical challenges posed by the detection of such findings. METHODS: The authors reviewed 151 research MRI scans obtained retrospectively from subjects recruited to studies as healthy volunteers. Incidental findings were classified into four categories: no referral, routine, urgent, or immediate referral. p Values for significance were computed from chi(2) tests of contingency. RESULTS: Of 151 studies, the authors found an overall occurrence of incidental findings having required referral of 6.6%. By age, there were more findings in the older cohort (aged >60 years) than in the younger cohort (p < 0.05) and in more men than women in the older cohort (p < 0.001). Three of four (75%) findings in the younger cohort were classified in the urgent referral category; 100% of the findings in the older cohort were classified as routine (p < 0.05). CONCLUSION: The significant presence but different characteristics of incidental findings in young and older subjects presumed to be neurologically healthy suggest that standards of practice are needed to guide investigators in managing and communicating their discovery.

Adolescent↗
PubMed2000

[Breast neoplasms detected only with ultrasonography: incidental finding or clinical evidence?].

INTRODUCTION: Mammography is the only technique of proven efficacy in the early diagnosis of breast cancer, even though its sensitivity is much lower in breasts that are dense or with a high parenchymal-stromal component. In the past malignant breast nodules detected at US in patients with negative mammographic and physical findings were considered incidental findings, but more recent papers report increasing numbers of breast cancers detected only at US. PURPOSE: We investigated the yield of US performed as a diagnostic complement in asymptomatic women with mammographic findings that were either negative or poorly readable because of dense breast. MATERIAL AND METHODS: We examined 13 women 37 to 55 years old (mean 47): 9 of them were asymptomatic and 4 had poorly specific physical findings. The patients underwent physical examination, mammography, US, microhistologic biopsy with 14G needles under US guidance and surgery. RESULTS: Fourteen breast lesions 7.0-15 mm in diameter were detected only by US. Mammography (2 or 3 standard views) was negative in all cases. The lesions detected only by US (10% of all carcinomas) were typified with US-guided needle biopsy and finally confirmed surgically. DISCUSSION AND CONCLUSIONS: Though obtained in a small series, our results seem to suggest that US should be included in the diagnostic work-up, especially of women with dense breast. Also, any hypoechoic lesion detected at breast US in clinically asymptomatic women with negative mammographic findings should be further investigated with US, needle aspiration or core biopsy to make the final diagnosis.

Adult↗
PubMed2005

Incidental findings in brain computed tomography scans of 3000 head trauma patients.

BACKGROUND: Limited reports exist about intracranial incidental findings on computed tomography (CT) imaging. We studied the frequency of incidental findings on 3000 brain CT scans of trauma patients. METHODS: Three thousands standard brain CT scans of trauma patients were evaluated for some incidental findings. Cisterna magna was evaluated in 1500 CT scans. RESULTS: In this study we found 30 incidental abnormalities that include 8 cases of tumor: 3 meningioma, 2 craniopharyngioma, 1 oligodendroglioma, 1 low-grade astrocytoma, and 1 medulloblastoma. Suspect osteoma was found in 3 cases. In 3 cases, abnormal calcification was found in pineal region, basal ganglia, and temporal horn area. Three suspect lipomas were found in midline and near midline of the brain. Arachnoid cyst was found in 7 cases and hydrocephaly in 3 cases. Large cisterna magna (>10 cm(3)) was found in 11 cases. CONCLUSION: Cisterna magna enlargement was the most common incidental finding and brain tumor and arachnoid cyst were next in frequency.

Adolescent↗
PubMed2002

[Diagnostic and therapeutic strategy for an incidental finding of an adrenal mass].

The incidental finding of an unsuspected adrenal mass ranges from 0.5% to 5% in abdominal CT series. The optimal diagnostic approach to such masses is to diagnose malignant or secretory tumors requiring excision and to otherwise avoid unnecessary surgery. Physical examination generally contributes little. A standard biochemical evaluation should include the measurement of 24 hour urinary catecholamines and metanephrine, urinary free cortisol and plasma cortisol levels at 8 a.m. and 8 p.m. combined with an overnight low-dose dexamethasone suppression test, serum potassium assay, and determination of upright plasma aldosterone to plasma renin activity. These tests will serve to screen for pheochromocytoma, subclinical Cushing's syndrome, and primary hyperaldosteronism respectively. Imaging characteristics suggestive of malignancy include: size greater than 4 cm., heterogeneous lesion and/or density greater than 20 Hounsfield Units on CT scan, slow enhancement with delayed washout after intravenous contrast injection on CT scan, and slightly decreased signal intensity in out of phase (fat suppressed) MR acquisition. Fine-needle aspiration biopsy should be performed only if metastatic disease is suspected. Adrenal scintigraphy with iodocholesterol may be useful where adenoma with subclinical Cushing's syndrome or solid tumor is suspected. In summary, the following strategy is recommended for the management of adrenal incidentalomas : mass lesions larger than 4 cm. and hormone-secreting tumors should be removed. All non-secreting adrenal incidentalomas smaller than 4 cm. in diameter should be followed by serial imaging at regular intervals (6, 12, and 36 months) and by endocrine reevaluation at one year.

Adrenal Cortex Function Tests↗
PubMed1991

[Clinical study of renal cell carcinoma as incidental finding].

Reports on renal cell carcinoma (RCC) as an incidental finding have been increasing in recent years as the imaging modalities including ultrasonography (US) and computerized tomography (CT) scan have gained popularity in clinical medicine. Because effective treatment in RCC is only surgical removal of the involved kidney even at present, it is imperative for urologists to find and to diagnose the RCC in early stage. Whether RCC found incidentally is in early stage cancer is not determined at present. To determine if the RCC found incidentally is in early stage cancer and if the survival rate is better than that of the RCC found with symptoms, we undertook the following study. Between December 1972 and March 1990, 65 patients with RCC were registered at the Department of Urology, Teikyo University Hospital. Of 65 patients 20 with RCC as an incidental finding were subjected to this study. 34 patients with RCC found with symptoms including hematuria were subjected to control group. Causes of the diagnosis in 20 patients included workup for non-urological diseases in 11 patients (55.0%), workup for urological disease other than RCC in 5 patients (25.0%) and routine medical checkup in 4 patients (20.0%). First-line imaging modalities for the diagnosis was US in 9 patients (45.0%), DIP in 6 patients (30.0%) and CT in 5 patients (25.0%). Size of the tumor, pathological stage (pT) and grade in these 20 patients were tended to be smaller and lower, respectively, but these results were not significant as compared to those of the control group. Incidence of the remote metastasis, at the time of diagnosis, however, was significantly lesser than that of the control group (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Intestinal malrotation as an incidental finding on CT in adults.

BACKGROUND: Intestinal malrotation in adults is usually an incidental finding on computed tomography (CT). We present the CT findings of 18 adult patients with malrotation and discuss the clinical implications. METHODS: Abdominal scans of 18 patients (12 women, six men; age range = 15-79 years) with intestinal malrotation were reviewed. Special attention was directed to the location of the superior mesenteric vessels, the location of the small and large bowels, the size of the uncinate process, the situs definition, and additional anomalies. RESULTS: The malrotation was an incidental finding in all but one patient. The malrotation was type Ia in 17 patients and IIc in the one symptomatic patient. The superior mesenteric vessels were vertically oriented in 10, inverted in two, normally positioned in four, and mirror imaged in two cases with situs ambiguus. All patients had aplasia of the pancreatic uncinate process, five had a short pancreas, and two had a preduodenal portal vein. Fourteen patients had a normal situs and four had heterotaxia. Seven patients had polysplenia, six of which with associated inferior vena cava anomalies. CONCLUSIONS: Intestinal malrotation can be diagnosed on CT by the anatomic location of a right-sided small bowel, left-sided colon, an abnormal relationship of the superior mesenteric vessels, and aplasia of the uncinate process. Awareness of these abnormalities is necessary to diagnose this anomaly. It should be sought in patients with a situs problem, inferior vena cava anomalies, polysplenia, or preduodenal portal vein. Although usually an incidental finding, it is important to diagnose such a malrotation because it may cause abdominal symptoms. Also, knowledge of associated vascular anomalies is important when abdominal surgery is planned.

Adolescent↗
PubMedDate not supplied

Angiomatous arteriovenous fistula between aorta, great cardiac vein and pulmonary artery. An incidental finding during mitral valvotomy.

The incidental finding of arteriovenous fistula after a thoracotomy performed for mitral commissurotomy is reported. The communication describes the post-operative diagnosis of an anomaly, as far as we know previously unreported, in which a fistula was found between the aorta, great cardiac vein and pulmonary artery in an angiomatous malformation situated over the base of the pulmonary artery. The main coronary arteries were of normal distribution.

Aorta, Thoracic↗
PubMedDate not supplied

Incidental findings on pediatric MR images of the brain.

BACKGROUND AND PURPOSE: Previous studies have addressed the prevalence of incidental findings in symptomatic and healthy adult populations. Our study aims to elucidate the prevalence of incidental findings in a healthy pediatric population. METHODS: We retrospectively reviewed 225 conventional brain MR imaging studies obtained during structural and functional brain imaging research in a cohort of neurologically healthy children (100 boys [44%] and 125 girls [56%]) ranging in age from younger than 1 month to 18 years. All MR images were reviewed, and two board-certified neuroradiologists categorized the findings by consensus. RESULTS: Incidental abnormalities were detected in 47 subjects (21%), while 79% of the images were normal. Of the 47 abnormalities detected, 17 (36%) required routine clinical referral; a single lesion (2%) required urgent referral. The occurrence of these findings in the male cohort was twice that of the female cohort; however, the percentage of subjects requiring either routine or urgent referral did not differ by sex (male subjects, 34%; female subjects, 39%). CONCLUSION: Although the frequency of clinically important incidental abnormalities was not high in the sample of children studied, the presence and variety of findings in any pediatric group is particularly important for both the welfare of the subject and for research in which knowledge of the subject's neurologic status is vital to the interpretation of the results. Despite the limitations of the study in terms of the age and ethnic distribution, this work highlights the need for the routine involvement of trained radiologists in these studies to ensure that such incidental findings are detected and that appropriate follow-up is provided.

Adolescent↗
PubMed2005

The management of indeterminate incidental findings detected at abdominal CT.

Abdominal computed tomography (CT) scans often have findings that are incidental to the reason the study was ordered. Several recent studies and reviews have addressed how these findings should be managed. This article summarizes current management strategies for several types of lesions that are commonly encountered. Some of these findings can be characterized without additional imaging (including simple renal cyst, angiomyolipoma, hepatic steatosis). Other findings are indeterminate. While some of these indeterminate incidental findings can be ignored based on statistical arguments (for example, a sharply circumscribed homogeneous low-attenuation renal lesion under 1 cm in patients without a predisposition to develop renal cell carcinoma), many may need additional imaging studies to either characterize them or demonstrate stability over time. Adhering to these strategies will hopefully reduce overutilization of imaging services while directing attention to those findings which need diagnostic or therapeutic interventions.

Abdominal Neoplasms↗