• William B Hall, Sherstin G Truitt, Leslie P Scheunemann, Sidharth A Shah, M Patricia Rivera, Leonard A Parker, and Shannon S Carson.
• Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Campus Box 7020, 130 Mason Farm Rd, Chapel Hill, NC 27514. scarson@med.unc.edu.
• Arch. Intern. Med. 2009 Nov 23;169(21):1961-5.

BackgroundChest computed tomographic angiograms (CTAs) are frequently ordered for evaluation of suspected pulmonary embolism (PE) in the emergency department, but non-PE findings are often noted. Our objective was to determine the prevalence and management implications of incidental findings on chest CTAs ordered to assess for PE.MethodsIn a cross-sectional study, we reviewed 589 pulmonary CTAs that were ordered in the emergency department of a tertiary care hospital. We measured the prevalence of PE and placed other findings into the following 3 categories: (1) findings that provided potential alternative explanations for acute symptoms, (2) incidental findings that required clinical or radiologic follow-up, and (3) other findings that required less urgent or no follow-up. We reviewed all newly diagnosed pulmonary nodules and significant thoracic adenopathy and determined standard recommended clinical follow-up.ResultsPulmonary embolism was found in 55 of 589 CTAs (9%). A total of 195 CTAs (33%) had findings that supported alternative diagnoses. A total of 141 patients (24%) had a new incidental finding that required diagnostic follow-up, including 73 patients (13%) with a new pulmonary nodule and 51 patients (9%) with new adenopathy. Using current clinical guidelines, follow-up computed tomography or another procedure would be recommended for 96% of patients with new incidental pulmonary nodules.ConclusionsThe CTAs that are ordered in the emergency department are more than twice as likely to find an incidental pulmonary nodule or adenopathy than a PE. Systematic approaches should be developed to help primary care physicians contend with a growing number of clinically relevant incidental radiologic findings.

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