E1848. On the Edge: Incidental Thoracic Findings on Non-Thoracic Exams
  1. Julian Sison; Yale University
  2. Babina Gosangi; Yale University
  3. Ami Rubinowitz; Yale University
  4. Leah Traube; Yale University
  5. Christopher Gange; Yale University
  6. Tarek Elkady; Yale University
  7. Anna Bader; Yale University
Computed tomography (CT) protocols involve scanning regions just beyond the borders of the intended area of concern due to complex human anatomy. Common examples include the lung apices on head and neck CT and the lung bases on CT examinations of the abdomen and pelvis. This practice can reveal incidental findings within the visualized chest. The interpreting radiologist is responsible for the entire image, and must therefore be able to detect and interpret those findings and clearly communicate what, if any, further follow-up is necessary. These findings can present a diagnostic challenge if they lie outside the interpreting radiologist's area of interest and expertise. Our objective is to review incidental thoracic findings commonly encountered on the edge and equip radiologists with the knowledge needed to provide appropriate clinical guidance. Appropriate management is critical to patient care, as well as healthcare costs.

Educational Goals / Teaching Points
We will review incidental thoracic findings at the lung apices and bases that can be encountered on non-thoracic CT examinations. Discussion of appropriate management of these findings will be discussed, including when to recommend additional imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will include imaging thoracic findings discovered on non-dedicated chest CT studies (such as CT scans of the neck, heart, shoulder, and abdomen). Some of these findings are more urgent than others, in which the referring physician needs to be notified in a timely manner. We will structure our presentation according to anatomical location of findings. For the lungs, we will discuss nodules, parenchymal scarring, interstitial lung disease, and cancer. For the heart, we will discuss pericardial cysts, pericardial effusions, thrombus, and tumors in the heart. Pleural pathology will include asbestos-related pleural disease, mesothelioma, pleural effusions, and pneumothorax. Mediastinal masses and lymph nodes will be shown. Vascular abnormalities, such as pulmonary emboli, aortic dissection, and aberrant anatomy, will also be included.

Although radiology has trended toward subspecialization, clinical practice demands familiarity with findings outside the domain of a single subspecialty. These findings may present diagnostic challenges to the interpreting radiologist and can be associated with increased health care costs due to subsequent imaging for further workup. Knowledge of thoracic conditions that can be encountered on the edge of examinations is essential to fulfilling the ethos of being responsible for the entire image and ensuring that relevant findings are communicated in a clear manner to referring physicians and their patients.