E2907. Life on the D-list: Management of Lesser-Known Incidental CT Findings for General Radiologists
  1. Ahmed Moawad; Mercy Catholic Medical Center
  2. Salama Chaker; Mercy Catholic Medical Center
  3. Basem Jaber; Mercy Catholic Medical Center
  4. Tasneem Elakhdar; Cairo University
  5. Mahmoud Shalaby; Mercy Catholic Medical Center
  6. Marion Brody; Mercy Catholic Medical Center
Exponential increase in imaging studies has resulted in substantial rise in incidentalomas. Many are clinically insignificant but create anxiety and financial burden. American College of Radiology (ACR) established the incidental findings committee to provide general guidance for incidentalomas, reduce unnecessary examinations, reduce overall cost, and improve patient health. Committee so far has produced 9 white papers covering a wide range of incidental findings. However, radiologists frequently encounter incidental findings that have not been codified in these white papers.

Educational Goals / Teaching Points
Introducing the implications of overlooking incidental findings, case based diagnosis and management of lesser known incidental findings apart from ACR white paper and its subcommittees, data-driven and evidence based literature review of lesser known incidentalomas, and highlighting the need for consensus about management of lesser known incidentalomas.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The ACR incidental findings project - implication of overlooking incidental findings, financial burden for patients, government and third party payers, nonconsensus management of lesser known incidentalomas, apart from those in ACR white papers, and need for data driven recommendations rather than expert recommendations. Lesser known Incidental findings on thoracic CT - breast incidental findings (e.g., Gynecomastia, Fibroadenoma), cardiovascular findings (e.g., mitral annulus calcifications), free-floating arterial thrombi, and intracardiac thrombus. Lesser known Incidental findings in gastrointestinal tract - incidental hepatobiliary findings include hepatic angiomyolipoma, hepatic steatosis and cirrhosis, gallbladder polyps and calcifications, incidental pancreatic findings including pancreatic lipomatosis, incidental calcifications and pancreatic ductal dilatation, incidental bowel findings, bowel wall incidentalomas include bowel wall thickening, pneumatosis intestinalis, submucosal fat deposition, appendicolith in multiple clinical scenarios, incidental mesenteric findings including misty mesentery, and enlarged mesenteric lymph nodes. Lesser known genitourinary incidental findings including bladder diverticula, and ureterocele and ectopic ureter.

The ACR incidental findings committee has produced 9 white papers providing general guidance for incidentalomas. However, innumerable incidental findings have not been codified in these white papers, and remain a potential source of patient anxiety and unnecessary medical expense. We proposed that these less-common findings should be part of a collective compendium of guidelines which may serve as a reference for radiologists and as a reservoir for further research.