In the startling strange world of modern imaging we continue to be stunned by the unexpected. As more and more people are subjected to CT, MRI and ultrasound scanning, a plethora of unexpected or serendipitous findings are revealed. If only we had the knowledge and wisdom to ignore most of these incidental findings, how many untold patients, their families, and physicians would sleep more soundly at night.
The typical surprise finding is that of an unexpected mass, the quaintly but appropriately named incidentaloma. Many physicians are unaware of the frequency of these masses in the general population. For example, up to 10% of the population harbors an incidentaloma of the adrenal gland (cyst or benign adrenal adenoma), many of which are picked up on CT or MRI scanning of the abdomen. Benign fluid-filled (cystic) masses are frequently seen in the breast, thyroid, kidney, liver, spleen, pancreas, and pituitary gland. The most common clinical example of a cystic or solid mass is the thyroid nodule, 99% of which are clinically meaningless. Another interesting statistic: Up to half the population over age 50 has cysts of the kidney.
The problem remains, when is an unexpected finding on a scan report an incidentaloma, and if so, what is to be done? More on this when I discuss the cascade effect, another noxious byproduct of modern medical science.