Skip to main content

Advertisement

Log in

“Incidentalomas” on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

The purpose of this article is to familiarize radiologists and clinicians with a subset of common and uncommon incidental findings on abdominal and pelvic computed tomography examinations, including hepatic, splenic, renal, adrenal, pancreatic, aortic/iliac arterial, gynecological, and a few other miscellaneous findings, with an emphasis on “incidentalomas” discovered in the emergency setting. In addition, we will review the complex problem of diagnosing such entities, and provide current management recommendations. Representative case examples, which we have encountered in our clinical practices, will be demonstrated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19

Similar content being viewed by others

References

  1. Berland LL, Silverman SG, Megibow AJ, Mayo-Smith WW (2014) ACR members’ response to JACR white paper on the management of incidental abdominal CT findings. J Am Coll Radiol 11:30–35

    Article  PubMed  Google Scholar 

  2. Shuaib W, Johnson JO, Salastekar N, et al. (2014) Incidental findings detected on abdomino-pelvic multidetector computed tomography performed in the acute setting. Am J Emerg Med 32:36–39

    Article  PubMed  Google Scholar 

  3. Clark TJ, Coats G (2016) Adherence to ACR incidental finding guidelines. J Am Coll Radiol S1546–1440(16):30316-7

    Google Scholar 

  4. Berland LL, Silverman SG, Gore RM, et al. (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773

    Article  PubMed  Google Scholar 

  5. Berland LL (2011) The American College of Radiology strategy for managing incidental findings on abdominal computed tomography. Radiol Clin North Am 49:237–243

    Article  PubMed  Google Scholar 

  6. Johnson PT, Horton KM, Megibow AJ, Jeffrey RB, Fishman EK (2011) Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol 8:762–767

    Article  PubMed  Google Scholar 

  7. Palsdottir HB, Hardarson S, Petursdottir V, et al. (2012) Incidental detection of renal cell carcinoma is an independent prognostic marker: results of a long-term, whole population study. J Urol 187:48–53

    Article  PubMed  Google Scholar 

  8. Naidu SG, Hara AK, Brandis AR, Stone WM (2010) Incidence of highly important extravascular findings detected on CT angiography of the abdominal aorta and the lower extremities. AJR 194:1630–1634

    Article  PubMed  Google Scholar 

  9. Sistrom CL, Dreyer KJ, Dang PP, et al. (2009) Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology 253:453–461

    Article  PubMed  Google Scholar 

  10. Choyke PL (2006) ACR appropriateness criteria on incidentally discovered adrenal mass. J Am Coll Radiol 3:498–504

    Article  PubMed  Google Scholar 

  11. Boland GWL, Blake MA, Hahn PF, Mayo-Smith WW (2008) Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 249:756–775

    Article  PubMed  Google Scholar 

  12. Hassan C, Pickhardt P, Laghi A, et al. (2008) Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm: model simulation with cost effectiveness analysis. Arch Intern Med 168:696–705

    Article  PubMed  Google Scholar 

  13. Ding A, Eisenberg JD, Pandharipande PV (2011) The economic burden of incidentally detected findings. Radiol Clin North Am 49:257–265

    Article  PubMed  PubMed Central  Google Scholar 

  14. Katz DS, Scheer M, Lumerman JH, et al. (2000) Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations. Urology 56:53–57

    Article  CAS  PubMed  Google Scholar 

  15. Monzawa S, Washio T, Yasuoka R, et al. (2013) Incidental detection of clinically unexpected breast lesions by computed tomography. Acta Radiol 54:374–379

    Article  PubMed  Google Scholar 

  16. Wu CC, Cronin CG, Chu JT, et al. (2012) Incidental pulmonary nodules detected on abdominal computed tomography. J Comput Assist Tomogr 36:641–645

    Article  PubMed  Google Scholar 

  17. Chan PL, Reddy T, Milne D, Bolland MJ (2012) Incidental vertebral fractures on computed tomography. N Z Med J 125:45–50

    PubMed  Google Scholar 

  18. Bartalena T, Giannelli G, Rinaldi MF, et al. (2009) Prevalence of thoracolumbar vertebral fractures on multidetector CT: underreporting by radiologists. Eur J Radiol 69:555–559

    Article  PubMed  Google Scholar 

  19. Katz DS, Ganson G, Klein MA, Mazzie JP (2013) CT of the skin and subcutaneous tissues. Emerg Radiol 20:57–68

    Article  PubMed  Google Scholar 

  20. Barille MF, Wu JS, McMahon CJ (2014) Femoral head avascular necrosis: a frequently missed incidental finding on multidetector CT. Clin Radiol 69:280–285

    Article  CAS  PubMed  Google Scholar 

  21. Gore RM, Newmark GM, Thakrar KH, Mehta UK, Berlin JW (2011) Hepatic incidentalomas. Radiol Clin North Am 49:291–322

    Article  PubMed  Google Scholar 

  22. American College of Radiology (2014) Liver Imaging Reporting and Data System. www.acr.org/Quality-Safety/Resources/LIRADS. Accessed 8 June 2016

  23. Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 3: white paper of the ACR incidental findings committee II on splenic and nodal findings. J Am Coll Radiol 10:833–839

    Article  PubMed  Google Scholar 

  24. Bosniak MA (2012) The Bosniak renal cyst classification: 25 years later. Radiology 262:781–785

    Article  PubMed  Google Scholar 

  25. Siegel CL, McFarland EG, Brink JA, et al. (1997) CT of cystic renal masses: analysis of diagnostic performance and interobserver variation. AJR 169:813–818

    Article  CAS  PubMed  Google Scholar 

  26. O’Connor SD, Pickhardt PJ, Kim DH, Oliva MR, Silverman SG (2011) Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding management. AJR 197:139–145

    Article  PubMed  Google Scholar 

  27. Pooler BD, Pickhardt PJ, O’Connor SD, et al. (2012) Renal cell carcinoma: attenuation values on unenhanced CT. AJR 198:1115–1120

    Article  PubMed  Google Scholar 

  28. Jonisch AI, Rubinowitz AN, Mutalik PG, Israel GM (2007) Can high-attenuation renal cysts be differentiated from renal cell carcinoma at unenhanced CT? Radiology 243:445–450

    Article  PubMed  Google Scholar 

  29. Silverman SG, Israel GM, Herts BR, Richie JP (2008) Management of the incidental renal mass. Radiology 249:16–31

    Article  PubMed  Google Scholar 

  30. Heilbrun ME, Remer EM, Casalino DD, et al. (2015) ACR Appropriateness Criteria indeterminate renal mass. J Am Coll Radiol 12:333–341

    Article  PubMed  Google Scholar 

  31. Mileto A, Nelson RC, Paulson EK, Marin D (2015) Dual-energy MDCT for imaging the renal mass. AJR 204:W640–W647

    Article  PubMed  Google Scholar 

  32. Ascenti G, Mazziotti S, Mileto A, et al. (2012) Dual-source dual-energy CT evaluation of complex cystic renal masses. AJR 199:1026–1034

    Article  PubMed  Google Scholar 

  33. Song JH, Chaudhry FS, Mayo-Smith WW (2007) The incidental indeterminate adrenal mass on CT (>10 H) in patients without cancer: is further imaging necessary? Follow-up of 321 consecutive indeterminate adrenal masses. AJR 189:1119–1123

    Article  PubMed  Google Scholar 

  34. Song JH, Chaudhry FS, Mayo-Smith WW (2008) The incidental adrenal mass on CT: prevalence of adrenal disease in 1049 consecutive adrenal masses in patients with no known malignancy. AJR 190:1163–1168

    Article  PubMed  Google Scholar 

  35. Mileto A, Nelson RC, Marin D, Choudhury KR, Ho LM (2014) Dual-energy multidetector CT for the characterization of incidental adrenal nodules: diagnostic performance of contrast-enhanced material density analysis. Radiology 274:445–454

    Article  PubMed  Google Scholar 

  36. Glazer DI, Keshavarzi NR, Maturen KE, et al. (2014) Adrenal incidentaloma triage with single source (fast kVp switch) dual energy CT. AJR 203:329–335

    Article  PubMed  PubMed Central  Google Scholar 

  37. Botsikas D, Triponez F, Boudabbous S, et al. (2014) Incidental adrenal lesions detected on enhanced abdominal dual-energy CT: can the diagnostic workup be shortened by the implementation of virtual unenhanced images? Eur J Radiol 83:1746–1751

    Article  PubMed  Google Scholar 

  38. Song JH, Mayo-Smith WW (2011) Incidentally discovered adrenal mass. Radiol Clin North Am 49:361–368

    Article  PubMed  Google Scholar 

  39. Gallotti A, Perez Johnston R, Bonaffini PA, et al. (2013) Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy. AJR 200:355–362

    Article  PubMed  Google Scholar 

  40. Gabata T, Terayama N, Yamashiro M, et al. (2005) Solid serous cystadenoma of the pancreas: MR imaging with pathologic correlation. Abdom Imaging 30:605–609

    Article  CAS  PubMed  Google Scholar 

  41. Manfredi R, Ventriglia A, Mantovani W, et al. (2015) Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization. Eur Radiol 25:940–949

    Article  PubMed  Google Scholar 

  42. Raman SP, Kawamoto S, Law JK, et al. (2013) Institutional experience with solid pseudopapillary neoplasms: focus on computed tomography, magnetic resonance imaging, conventional ultrasound, endoscopic ultrasound, and predictors of aggressive histology. J Comput Assist Tomogr 37:824–833

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kawamoto S, Johnson PT, Hall H, et al. (2012) Intrapancreatic accessory spleen: CT appearance and differential diagnosis. Abdom Imaging 37:812–827

    Article  PubMed  Google Scholar 

  44. Sahani DV, Kadavigere R, Saokar A, et al. (2005) Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. RadioGraphics 25:1471–1484

    Article  PubMed  Google Scholar 

  45. Katz DS, Friedel DM, Kho D, Georgiou N, Hines JJ (2007) Relative accuracy of CT and MRI for characterization of cystic pancreatic masses. AJR 189:657–661

    Article  PubMed  Google Scholar 

  46. Lennon AM, Manos LL, Hruban RH, et al. (2014) Role of a multidisciplinary clinic in the management of patients with pancreatic cysts: a single-center cohort study. Ann Surg Oncol 21:3668–3674

    Article  PubMed  PubMed Central  Google Scholar 

  47. Brook OR, Beddy P, Pahade J, et al. (2016) Delayed growth in incidental pancreatic cysts: are the current American College of Radiology recommendations for follow-up appropriate? Radiology 278:752–761

    Article  PubMed  Google Scholar 

  48. Tanaka M, Fernández-del Castillo C, Adsay V, et al. (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197

    Article  PubMed  Google Scholar 

  49. Vege SS, Ziring B, Jain R, et al. (2015) American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819–822

    Article  PubMed  Google Scholar 

  50. Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 2: white paper of the ACR incidental findings committee II on vascular findings. J Am Coll Radiol 10:789–794

    Article  PubMed  Google Scholar 

  51. Al-Thani H, El-Menyar A, Shabana A, et al. (2014) Incidental abdominal aneurysms: a retrospective study of 13,115 patients who underwent a computed tomography scan. Angiology 65:388–395

    Article  PubMed  Google Scholar 

  52. Pickhardt PJ, Hanson ME (2010) Incidental adnexal masses detected at low-dose unenhanced CT in asymptomatic women age 50 and older: implications for clinical management and ovarian cancer screening. Radiology 257:144–150

    Article  PubMed  Google Scholar 

  53. Hanna TN, Shekhani H, Zygmont ME, Kerchberger JM, Johnson JO (2016) Incidental findings in emergency imaging: frequency, recommendations, and compliance with consensus guidelines. Emerg Radiol 23:169–174

    Article  PubMed  Google Scholar 

  54. Patel MD, Ascher SM, Paspulati RM, et al. (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR incidental findings committee II on adnexal findings. J Am Coll Radiol 10:675–681

    Article  PubMed  Google Scholar 

  55. Levine D, Brown DL, Andreotti RF, et al. (2010) Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 256:943–954

    Article  PubMed  Google Scholar 

  56. Sebastian S, Araujo C, Neitlich JD, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 4: white paper of the ACR incidental findings committee II on gallbladder and biliary findings. J Am Coll Radiol 10:953–956

    Article  PubMed  Google Scholar 

  57. Kelly ME, Heeney A, Redmond CE, et al. (2015) Incidental findings detected on emergency abdominal CT scans: a 1-year review. Abdom Imaging 40:1853–1857

    Article  CAS  PubMed  Google Scholar 

  58. Katz DS, Jorgensen MJ, Rubin GD (1999) Detection and follow-up of important extra-arterial lesions with helical CT angiography. Clin Radiol 54:294–300

    Article  CAS  PubMed  Google Scholar 

  59. Iezzi R, Cotroneo AR, Filippone A, et al. (2007) Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremity arteries: a retrospective review study. Abdom Imaging 32:489–494

    Article  PubMed  Google Scholar 

  60. Ozao-Choy J, Kim U, Vieux U, Menes TS (2011) Incidental findings on computed tomography scans for acute appendicitis: prevalence, costs, and outcome. Am Surg 77:1502–1509

    PubMed  Google Scholar 

  61. Halverson M, Delgado J, Mahboubi S (2014) Extra-appendiceal findings in pediatric abdominal CT for suspected appendicitis. Pediatr Radiol 44:816–820

    Article  PubMed  Google Scholar 

  62. Ekeh AP, Walusimbi M, Brigham E, Woods RJ, McCarthy MC (2010) The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. J Emerg Med 38:484–489

    Article  PubMed  Google Scholar 

  63. Munk MD, Peitzman AB, Hostler DP, Wolfson AB (2010) Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center. J Emerg Med 38:346–350

    Article  PubMed  Google Scholar 

  64. van Vugt R, Dekker HM, Deunk J, et al. (2011) Incidental findings on routine thoracoabdominal computed tomography in blunt trauma patients. J Trauma 72:416–421

    Google Scholar 

  65. Morgan AE, Berland LL, Ananyev SS, Lockhart ME, Kolettis PN (2015) Extraurinary incidental findings on CT for hematuria: the radiologist’s role and downstream cost analysis. AJR 204:1160–1167

    Article  PubMed  Google Scholar 

  66. Garrett RW, Nepute JC, Hayek ME, Albert SG (2016) Adrenal incidentalomas: clinical controversies and modified recommendations. AJR 206:1170–1178

    Article  PubMed  Google Scholar 

  67. Collins CE, Cherng N, McDade T, et al. (2015) Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol. J Trauma Manag Outcomes 9:1

    Article  PubMed  PubMed Central  Google Scholar 

  68. Berlin L (2013) How do you solve a problem like incidentalomas? Appl Radiol. http://appliedradiology.com/articles/how-do-you-solve-a-problem-like-incidentalomas. Accessed 5/25/2016

  69. Pandharipande PV, Herts BR, Gore RM, et al. (2016) Rethinking normal: benefits and risks of not reporting harmless incidental findings. J Am Coll Radiol 13:764–767

    Article  PubMed  Google Scholar 

  70. Berlin L (2015) Communicating nonroutine radiologic findings to the ordering physician: will (should) information technology-assisted communication replace direct voice contact? Radiology 277:332–336

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Siavash Behbahani.

Ethics declarations

Funding

This review article was not funded by any entity.

Conflict of interest

Author Siavash Behbahani declares that he has no conflict of interest. Author Sameer Mittal declares that he has no conflict of interest. Author Michael N. Patlas declares that he has no conflict of interest. Author Mariam Moshiri declares that she has no conflict of interest. Author Christine O. Menias declares that she has no conflict of interest. Author Douglas S. Katz declares that he has no conflict of interest.

Ethical approval

This is a review article. This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Behbahani, S., Mittal, S., Patlas, M.N. et al. “Incidentalomas” on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations. Abdom Radiol 42, 1046–1061 (2017). https://doi.org/10.1007/s00261-016-0914-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0914-5

Keywords

Navigation