Document Detail

The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism.
MedLine Citation:
PMID:  19933956     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chest computed tomographic angiograms (CTAs) are frequently ordered for evaluation of suspected pulmonary embolism (PE) in the emergency department, but non-PE findings are often noted. Our objective was to determine the prevalence and management implications of incidental findings on chest CTAs ordered to assess for PE. METHODS: In a cross-sectional study, we reviewed 589 pulmonary CTAs that were ordered in the emergency department of a tertiary care hospital. We measured the prevalence of PE and placed other findings into the following 3 categories: (1) findings that provided potential alternative explanations for acute symptoms, (2) incidental findings that required clinical or radiologic follow-up, and (3) other findings that required less urgent or no follow-up. We reviewed all newly diagnosed pulmonary nodules and significant thoracic adenopathy and determined standard recommended clinical follow-up. RESULTS: Pulmonary embolism was found in 55 of 589 CTAs (9%). A total of 195 CTAs (33%) had findings that supported alternative diagnoses. A total of 141 patients (24%) had a new incidental finding that required diagnostic follow-up, including 73 patients (13%) with a new pulmonary nodule and 51 patients (9%) with new adenopathy. Using current clinical guidelines, follow-up computed tomography or another procedure would be recommended for 96% of patients with new incidental pulmonary nodules. CONCLUSIONS: The CTAs that are ordered in the emergency department are more than twice as likely to find an incidental pulmonary nodule or adenopathy than a PE. Systematic approaches should be developed to help primary care physicians contend with a growing number of clinically relevant incidental radiologic findings.
William B Hall; Sherstin G Truitt; Leslie P Scheunemann; Sidharth A Shah; M Patricia Rivera; Leonard A Parker; Shannon S Carson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of internal medicine     Volume:  169     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2009-12-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1961-5     Citation Subset:  AIM; IM    
Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Campus Box 7020, 130 Mason Farm Rd, Chapel Hill, NC 27514.
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MeSH Terms
Academic Medical Centers
Anoxia / etiology
Cross-Sectional Studies
Diagnosis, Differential
Dyspnea / etiology
Emergency Service, Hospital
Incidental Findings*
Lung Neoplasms / complications,  radiography*
Lymphatic Diseases / complications,  radiography*
Mediastinal Neoplasms / complications,  radiography*
Middle Aged
Neoplasms / radiography
Pulmonary Artery / radiography*
Pulmonary Embolism / complications,  radiography*
Tachycardia / etiology
Tomography, X-Ray Computed*
Comment In:
Arch Intern Med. 2009 Nov 23;169(21):1966-8   [PMID:  19933957 ]

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