ARRS 2022 Abstracts


E1722. Incidental Findings Identified During Whole Body CT Imaging of Trauma Patients: Are They Clinically Significant?
  1. Douglas Layman; University of Tennessee Health Science Center
  2. Trevor Marquand; University of Tennessee Health Science Center
  3. Kristen Harmon; University of Tennessee Health Science Center
  4. Louis Magnotti; University of Tennessee Health Science Center
  5. Jeremiah Deneve; University of Tennessee Health Science Center
Whole body CT imaging (WBI) is frequently utilized during initial trauma evaluation. CT imaging allows prompt identification of life-threatening injuries but may reveal incidental radiographic findings unrelated to the trauma event. We evaluated the incidence and clinical significance of incidental radiographic findings in patients undergoing trauma evaluation.

Materials and Methods:
A retrospective review (January–September 2016) of trauma patients who underwent CT imaging (chest, abdomen, and pelvis, [CAP]) for blunt mechanism injury was performed. Non-trauma related incidental radiographic findings were further examined. Incidental findings were characterized as benign-appearing, uncertain etiology, or malignant-appearing.

A total of 936 patients underwent CAP, and 428 (46%) patients had an incidental finding upon initial trauma evaluation imaging. Of the patients with incidental findings, 381 were benign-appearing; the most common included renal cysts (29%), pulmonary granulomas (24%), mediastinal granulomas (14%), and liver cysts (11%). There were 144 patients (24%) with findings of uncertain etiology at initial imaging; the most common included lung (17%), thyroid (16%), and adrenal nodules (13%). There were no initial incidental findings characterized as malignant. Further diagnostic evaluation was recommended for 65 (15%) patients based on uncertain initial findings. Of these 65 patients, 59 (91%) patients had no follow up imaging documented. Nine (14%) patients had additional follow up imaging with a median follow up of 24 months. Two patients underwent subsequent invasive diagnostic workup, thyroid biopsy, and colonoscopy. One patient was diagnosed with adenocarcinoma of the colon upon subsequent workup.

Incidental radiographic findings during trauma evaluation are common, the majority of which are benign-appearing and require no further diagnostic evaluation. In this study, a quarter of incidental findings were of uncertain etiology, but nearly half represent findings with broadly accepted guidelines for management. The remaining incidental lesions necessitate further work-up. Trauma patients are vulnerable to delayed and disjointed follow up resulting in inefficient care.