DOI QR코드

DOI QR Code

Prevalences of Incidental Findings in Trauma Patients by Abdominal and Pelvic Computed Tomography

  • Lee, Jin Young (Department of Surgery, Yonsei University College of Medicine) ;
  • Jung, Myung Jae (Department of Surgery, Yonsei University College of Medicine) ;
  • Lee, Jae Gil (Department of Surgery, Yonsei University College of Medicine) ;
  • Lee, Seung Hwan (Department of Surgery, Yonsei University College of Medicine)
  • Received : 2016.07.07
  • Accepted : 2016.09.12
  • Published : 2016.09.30

Abstract

Purpose: Abdominal and pelvic computed tomography (APCT) is frequently used as a diagnostic tool in trauma patients. However, trauma unrelated, incidental findings are frequently encountered. The aim of this study was to determine the prevalences of incidental findings on APCT scans in trauma patients. Methods: The archived records of 801 trauma patients treated from January 2013 to December 2015 were reviewed retrospectively. Six hundred and forty of these patients underwent contrast enhanced APCT in an emergency department and were included in this study, and 205 (32.1%) of these patients had incidental findings. These findings were divided into two categories: category I, meaning a radiological benign finding not requiring further evaluation or follow-up, and category II, requiring further evaluation and follow-up. Results: One hundred and sixty (24.8%) patients were allocated to category I and 45 (7.2%) to category II. The most frequent incidental findings were discovered in kidneys (34.6%), followed by liver (28.8%), and gallbladder (15.6%). The most frequent finding in category I was a benign cyst (60.1%), followed by a simple stone (15.6%), and hemangioma (11.9%). Adenomyomatosis of the gallbladder (17.8%) was the most common lesion in category II, followed by atypical mass (15.6%), complicated stone (15.6%) and cystic neoplasm (15.6%). Conclusion: The prevalence of an incidental finding on APCT scans was 32.1%. Although category II lesions were not common in trauma patients, these findings should be communicated to patients, and when necessary referred to a primary care physician. Systems are required for producing appropriate discharge summaries and informing patients about the implications of incidental findings.

Keywords

References

  1. Beckmann EC. CT scanning the early days. Br J Radiol 2006; 79: 5-8. https://doi.org/10.1259/bjr/29444122
  2. Prokop M. General principles of MDCT. Eur J Radiol 2003; 45: S4-10. https://doi.org/10.1016/S0720-048X(02)00358-3
  3. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006; 141: 468-73; discussion 73-5. https://doi.org/10.1001/archsurg.141.5.468
  4. Sampson MA, Colquhoun KB, Hennessy NL. Computed tomography whole body imaging in multi-trauma: 7 years experience. Clin Radiol 2006; 61: 365-9. https://doi.org/10.1016/j.crad.2005.12.009
  5. Wisbach GG, Sise MJ, Sack DI, Swanson SM, Sundquist SM, Paci GM, et al. What is the role of chest X-ray in the initial assessment of stable trauma patients? J Trauma 2007; 62: 74- 8; discussion 8-9. https://doi.org/10.1097/01.ta.0000251422.53368.a3
  6. Paluska TR, Sise MJ, Sack DI, Sise CB, Egan MC, Biondi M. Incidental CT findings in trauma patients: incidence and implications for care of the injured. J Trauma 2007; 62: 157-61. https://doi.org/10.1097/01.ta.0000249129.63550.cc
  7. Barrett TW, Schierling M, Zhou C, Colfax JD, Russ S, Conatser P, et al. Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med 2009; 27: 428-35. https://doi.org/10.1016/j.ajem.2008.03.025
  8. Ekeh AP, Walusimbi M, Brigham E, Woods RJ, McCarthy MC. The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. J Emerg Med 2010; 38: 484-9. https://doi.org/10.1016/j.jemermed.2008.11.019
  9. Munk MD, Peitzman AB, Hostler DP, Wolfson AB. Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center. J Emerg Med 2010; 38: 346-50. https://doi.org/10.1016/j.jemermed.2008.01.021
  10. Berlin L. Potential legal ramifications of whole-body CT screening: taking a peek into Pandora's box. AJR Am J Roentgenol 2003; 180: 317-22. https://doi.org/10.2214/ajr.180.2.1800317
  11. Elgin EE, O'Malley PG, Feuerstein I, Taylor AJ. Frequency and severity of “incidentalomas” encountered during electron beam computed tomography for coronary calcium in middleaged army personnel. Am J Cardiol 2002; 90: 543-5. https://doi.org/10.1016/S0002-9149(02)02533-X
  12. Hunold P, Schmermund A, Seibel RM, Gronemeyer DH, Erbel R. Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification. Eur Heart J 2001; 22: 1748-58. https://doi.org/10.1053/euhj.2000.2586
  13. Messersmith WA, Brown DF, Barry MJ. The prevalence and implications of incidental findings on ED abdominal CT scans. Am J Emerg Med 2001; 19: 479-81. https://doi.org/10.1053/ajem.2001.27137
  14. van Vugt R, Dekker HM, Deunk J, van der Vijver RJ, van Vugt AB, Kool DR, et al. Incidental Findings on Routine Thoracoabdominal Computed Tomography in Blunt Trauma Patients. J Trauma 2011.
  15. Ruesseler M, Schill A, Lehnert T, Wyen H, Wutzler S, Marzi I, et al. Incidental findings in patients with multiple injuries: how to proceed? J Trauma Acute Care Surg 2013; 75: 848-53. https://doi.org/10.1097/TA.0b013e3182a925b9
  16. Seah MK, Murphy CG, McDonald S, Carrothers A. Incidental findings on whole-body trauma computed tomography: Experience at a major trauma centre. Injury 2016; 47: 691-4. https://doi.org/10.1016/j.injury.2016.01.012
  17. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010; 7: 754-73. https://doi.org/10.1016/j.jacr.2010.06.013
  18. Iezzi R, Cotroneo AR, Filippone A, Di Fabio F, Merlino B, Bonomo L. Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremity arteries: a retrospective review study. Abdom Imaging 2007; 32: 489-94. https://doi.org/10.1007/s00261-006-9136-6
  19. Wutzler S, Lefering R, Laurer HL, Walcher F, Wyen H, Marzi I. [Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry]. Unfallchirurg 2008; 111: 592-8. https://doi.org/10.1007/s00113-008-1448-2
  20. Tornetta P, 3rd, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, et al. Morbidity and mortality in elderly trauma patients. J Trauma 1999; 46: 702-6. https://doi.org/10.1097/00005373-199904000-00024
  21. Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am 2010; 39: 359-67. https://doi.org/10.1016/j.gtc.2010.02.001
  22. Ootani T, Shirai Y, Tsukada K, Muto T. Relationship between gallbladder carcinoma and the segmental type of adenomyomatosis of the gallbladder. Cancer 1992; 69: 2647-52. https://doi.org/10.1002/1097-0142(19920601)69:11<2647::AID-CNCR2820691105>3.0.CO;2-0
  23. Mellnick VM, Menias CO, Sandrasegaran K, Hara AK, Kielar AZ, Brunt EM, et al. Polypoid Lesions of the Gallbladder: Disease Spectrum with Pathologic Correlation-Erratum. Radiographics 2015; 35: 1316.
  24. Kim JH, Jeong IH, Han JH, Kim JH, Hwang JC, Yoo BM, et al. Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis. Hepatogastroenterology 2010; 57: 420-5.
  25. Aldridge MC, Gruffaz F, Castaing D, Bismuth H. Adenomyomatosis of the gallbladder. A premalignant lesion? Surgery 1991; 109: 107-10.
  26. Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 2005; 63: 550-3; discussion 3. https://doi.org/10.1016/j.surneu.2004.07.049
  27. Shetty SK, Maher MM, Hahn PF, Halpern EF, Aquino SL. Significance of incidental thyroid lesions detected on CT: correlation among CT, sonography, and pathology. AJR Am J Roentgenol 2006; 187: 1349-56. https://doi.org/10.2214/AJR.05.0468
  28. Semelka RC, Armao DM, Elias J, Jr., Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 2007; 25: 900-9. https://doi.org/10.1002/jmri.20895