Common Incidental Finding Research Articles

Adrenal incidentaloma - differential diagnosis and management

Adrenal masses are common incidental findings on imaging procedures.In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but in up to 20 % they require therapeutic intervention. The aim of this article is to provide essential guidance for clinicians regarding clinical management of patients with adrenal incidentalomas based on the respective current clinical guidelines. The following main questions are addressed: How to distinguish a nonfunctioning incidentaloma from a functioning one and how to assess risk of malignancy? How to define and manage low-level autonomous cortisol secretion, formerly called "subclinical" Cushing's syndrome? Which patients have to be treated surgically and which approach should be used? What follow-up is indicated if the adrenal incidentaloma is not surgically removed?

Achados incidentais focais no abdome superior encontrados na tomografia computadorizada de tórax sem contraste que não requerem investigação adicional: roteiro para o radiologista torácico

Chest scans usually include the upper abdomen, leading radiologists to evaluate the upper abdominal structures. The aim of this article is to summarize the most common incidental upper abdominal findings that do not require further imaging or management in patients undergoing unenhanced computed tomography of the chest for the investigation of thoracic symptoms or diseases. We review common incidental findings of the liver, gallbladder, spleen, adrenal glands, kidney, and retroperitoneum, as well as findings that mimic other lesions. Thoracic radiologists should be aware of such typical findings and report when no further investigation is needed, thus avoiding unnecessary imaging examinations, protecting patients from additional medical interventions, and allaying patient concerns.

Incidence, Risk Factors, and Patient Management of Incidental Coronary Artery Calcification on Non-ECG Gated Computed Chest Tomography: A Systematic Review

Coronary artery calcification (CAC) is an independent predictor of cardiovascular events and can be reliably detected on non-Electrocardiogram (ECG) gated computed tomography (CT) scans. The increased use of CT has made CAC a common incidental finding, although the frequency remains variable in published literature. We aimed to identify the incidence of CAC found on routine non-ECG gated CT scans, risk factors associated with these findings, and management outcomes that resulted from discovery of CAC. A systematic review was conducted through literature search using predetermined search criteria. Applicable studies were screened by 3 investigators for eligibility. Data regarding indication for CT imaging, presence of CAC, cardiovascular risk factors, and management outcomes was collected. A total of 3585 study subjects were included for review. CAC was found in 31.2% (n = 1118) patients. Indications for CT imaging were 33.0% lung cancer screening, 16.0% for intrapulmonary pathology, and 50.0% for other reasons. In patients with CAC, the average age was 61.5 + 8.8 years old, 77.2% were male, 41.4% were smokers, 32.2% had hypertension, 31.5% had hyperlipidemia, and 11.2% had diabetes. Patients with CAC were older (p < 0.001), more likely to be smokers (p = 0.002), and more likely to have hyperlipidemia (p < 0.001). The presence of CAC in reports did not significantly alter management plans. In conclusion, traditional cardiovascular risk factors are associated with incidental CAC. Not reporting incidental CAC is a missed opportunity for identification of patient at increased risk of cardiovascular events in the community.

359 Incidental Fatty Liver Disease; Are We Adhering to Guidelines?

Abstract Aim Hepatic steatosis is an increasingly prevalent condition, with estimates of up to 30% amongst western populations. Fatty liver is a common incidental finding on abdominal imaging. Current British Society of Gastroenterology guidelines suggest the use of scoring systems, such as FIB-4 or NFS, to stratify these patients into risk categories for the development of non-alcoholic steatohepatitis, and subsequent liver failure or hepatocellular carcinoma. We carried out an audit of our own practice, to see if these guidelines were being followed. Method We interrogated the national imaging management system to identify all scans performed in Wexford general hospital from 16th April to 16th October 2020 which identified “hepatic steatosis” or “fatty liver”. Data extracted included: patient demographics, imaging modality & finding. We correlated this data with the patient’s LFTs to calculate their FIB-4/NFS score and investigated whether suitable patients had been referred to gastroenterology. Results Of the 145 patients identified as having hepatic steatosis on imaging, 65 (44.8%) had ALT derangement, 42 (29%) had ALP derangement, 81 (56%) had GGT derangement and 23 (16%) had an elevated total bilirubin. Only 26 (17.9%) of these patients had evidence of subsequent liver serology studies, and only 11 (7.6%) had been referred to gastroenterology. None of the patient cohort had either a FIB-4 or NFS score calculated. Conclusions There is clear evidence that guidelines are not being followed in the management of patients who are incidentally found to have hepatic steatosis.

Hypothyroidism-Related Cardiac Tamponade

Thyroid dysfunction is a common incidental finding among healthy individuals. It can affect various organs of the body, including the heart. Among many other heart complications, it can lead to pericardial effusion by causing increased permeability of albumin across the pericardial membrane that leads to exudative pericardial effusion. In hypothyroidism, the fluid collection process occurs over a period of months, giving enough time for the pericardial membrane to stretch and accommodate the fluid within itself without causing any symptoms. Eventually, the pericardial membrane stretches to its maximum capacity and has no room to accommodate any more fluid, resulting in cardiac tamponade in the patients. Patients with hypothyroidism-related cardiac tamponade usually remain asymptomatic or present with atypical symptoms such as bradycardia and a normal heart rate or high blood pressure, and the diagnosis comes into light only when patients present to the hospital with hemodynamic instability. In these cases, echocardiography successfully detects large pericardial effusion with collapsed cardiac chambers. To treat hypothyroidism-related cardiac tamponade, treating the underlying condition has been very successful in the majority of the asymptomatic patients, but pericardiocentesis is required in emergencies to relieve symptoms of patients presenting with hemodynamic instability.We believe hypothyroidism-related cardiac tamponade is a preventable condition if detected and treated in outpatient settings by family physicians. This will prevent occurrence of various complications arising from hypothyroidism, including pericardial effusion. This will lead to a better quality of life among patients with the added benefit of reduced health care burden due to reduced frequency of hospital admissions of acutely ill patients.

MANAGEMENT OF CORONARY ARTERY CALCIFICATION IN PATIENTS ENROLLED IN A LOW-DOSE COMPUTERIZED TOMOGRAPHY LUNG CANCER SCREENING PROGRAM

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: The most common incidental finding in Griffin Hospital’s Lung Cancer Screening Program is coronary artery calcification (CAC), which serves as a sign of Coronary Artery Disease and a predictor of adverse cardiac events. We sought to assess how incidental findings of CAC are managed in patients at high risk for lung cancer. METHODS: We performed a single-center retrospective chart review of patients enrolled in a low-dose computerized tomography (LDCT) Lung Cancer Screening Program and a telephone survey including demographic characteristics, medical history, and patient perceptions of their disease and treatment. Patients were included if their initial scan showed moderate or severe CAC and if their scans were performed at least three months prior to the survey date to ensure that they were able to meet with their physicians and take any necessary actions. RESULTS: 35 of 78 patients who met inclusion criteria agreed to participate in the study. Actions directed at incidental findings of CAC were performed in only 60% (N=21) of these patients – 48% underwent coronary stress testing, 33% were prescribed aspirin and/or a statin, 24% quit or reduced smoking, 14% made modifications to their diet and exercise regimens, and 5% underwent stenting of a coronary artery; one patient had recently (< 1 year) undergone cardiac workup. The remaining 40% (N=14) of patients had no identifiable action or treatment to address CAC findings. 50% of these patients (N=7) were instructed by their physicians to make lifestyle changes but denied making those changes. The remaining 50% (N=7) deny ever discussing CAC with their physicians. Finally, when asked about their level of concern regarding CAC on a scale of 1-10 (with 10 being the greatest concern), the mean patient response was 4.9. CONCLUSIONS: Actions addressing incidental CAC were only performed in 60% of patients. 20% of patients disregarded instructions from their physicians to make lifestyle changes. Although the Lung Cancer Screening Program emphasizes the importance of incidental CAC to patients and their physicians, the remaining 20% of patients report never discussing CAC with their physicians. This apparent breakdown in communication may be a significant driver of the inaction in response to significant findings. Patients are only moderately concerned about CAC. CLINICAL IMPLICATIONS: Although LDCT screening for lung cancer often returns significant incidental CAC, these findings do not lead to changes in a large subset of patients. DISCLOSURES: No relevant relationships by Riley Kermanian, source=Web Response No relevant relationships by Jo-Ann Persson, source=Web Response No relevant relationships by Richard Salzano, source=Web Response

Variation in Radiologists' Follow-Up Imaging Recommendations for Small Cystic Pancreatic Lesions.

This study aimed to determine the incidence, identify imaging and patient factors, and measure individual radiologist variation associated with follow-up recommendations for small focal cystic pancreatic lesions (FCPLs), a common incidental imaging finding. This institutional review board-approved retrospective study analyzed 146,709 reports from abdominal CTs and MRIs performed in a large academic hospital from July 1, 2016, to June 30, 2018. A trained natural language processing tool identified 4,345 reports with FCPLs, which were manually reviewed to identify those containing one or more <1.5-cm pancreatic cysts. For these patients, patient, lesion, and radiologist features and follow-up recommendations for FCPL were extracted. A nonlinear random-effects model estimated degree of variation in follow-up recommendations across radiologists at department and division levels. Of 2,872 reports with FCPLs < 1.5 cm, 708 (24.7%) had FCPL-related follow-up recommendations. Average patient age was 67 years (SD ± 11). In all, 1,721 (60.0%) reports were for female patients; 59.3% of patients had only one cyst. In multivariable analysis, older patients had slightly lower follow-up recommendation rates (odds ratio [OR]: 0.98 [0.98-1.00] per additional year), and lesions associated with main duct dilatation and septation were more likely to have a follow-up recommendation (ORs: 1.93 [1.11-3.36] and 2.88 [1.89-4.38], respectively). Radiologist years in practice (P= .51), trainee presence (P= .21), and radiologist gender (P= .52) were not associated with increased follow-up recommendations. There was significant interradiologist variation in the Abdominal Imaging Division (P= .04), but not in Emergency Radiology (P= .31) or Cancer Imaging Divisions (P= .29). Interradiologist variation significantly contributes to variability in follow-up imaging recommendations for FCPLs.

Case Report: Challenges on diagnosis and therapy of malignant adrenal oncocytic neoplasm

Background: Adrenal masses are common incidental findings, most of which are benign and non-functional. Malignant adrenal tumors, however, differ from their benign counterpart and confer poor prognosis. In addition, the oncocytic variants of these tumors present challenges to clinicians owing to their unique biologic behavior and rarity. Case presentation: We present a case report of a 61-year-old male with a T2N0M0 adrenocortical oncocytic neoplasm of the right adrenal gland. The patient complained of worsening right upper quadrant abdominal pain and was diagnosed with a right adrenal mass after an abdominal CT-scan examination two weeks before. Subsequently, the patient underwent open adrenalectomy due to a history of abdominal surgery. Due to unique oncocytic biologic behavior, we used the Lin–Weiss–Bisceglia criteria to predict a malignancy instead of the Weiss system. We only found one malignant criterion, which showed a small tumor invasion on the vascular bed on one histopathological section. Thus, we diagnosed it as malignant adrenocortical oncocytic neoplasm. Furthermore, the PET Scan showed no residual mass or pathological metabolic activity on the tumor bed and metastatic sign. Conclusions: The diagnosis of the malignant oncocytic adrenal case is based on the histopathological criteria. Based on this case, we suggest a thorough histopathological examination to determine malignant criteria in adrenal neoplasm cases.

A Pathologist’s Perspective on Histopathology Examination of Autopsies and Various Incidental Findings

Background-The current study aims to highlight the importance of autopsies in not just finding the causeof death; but also, incidental discovery of various rare lesions, that may or may not be the cause of death.The study also aims to highlight the common cause of death, spectrum of common incidental findings andreporting of various rare, interesting cases. Method- This is a retrospective study conducted between year2013 to 2020 on 800 autopsies and their histopathological examination in Pathology Department, GMC,Patiala. Conclusion- Finding of this study concludes the importance of histopathological autopsy in not justhighlighting the cause of death but also finding many rare diseases, thus enriching the field of medicine andpathology by observing the histological findings and also sometimes the course of rare diseases.

Interstitial Lung Abnormalities: State of the Art.

The clinical importance of interstitial lung abnormality (ILA) is increasingly recognized. In July 2020, the Fleischner Society published a position paper about ILA. The purposes of this article are to summarize the definition, existing evidence, clinical management, and unresolved issues for ILA from a radiologic standpoint and to provide a practical guide for radiologists. ILA is a common incidental finding at CT and is often progressive and associated with worsened clinical outcomes. The hazard ratios for mortality range from 1.3 to 2.7 in large cohorts. Risk factors for ILA include age, smoking status, other inhalational exposures, and genetic factors (eg, gene encoding mucin 5B variant). Radiologists should systematically record the presence, morphologic characteristics, distribution, and subcategories of ILA (ie, nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic), as these are informative for predicting progression and mortality. Clinically significant interstitial lung disease should not be considered ILA. Individuals with ILA are triaged into higher- and lower-risk groups depending on their risk factors for progression, and systematic follow-up, including CT, should be considered for the higher-risk group. Artificial intelligence-based automated analysis for ILA may be helpful, but further validation and improvement are needed. Radiologists have a central role in clinical management and research on ILA.

Prediction of the histopathological tumor type of newly diagnosed liver lesions from standard abdominal computer tomography with a machine-learning classifier based on convolutional neural networks

Abstract Background and objectives: Liver lesions are a relatively common incidental finding in computer tomography (CT) of the abdomen. The current gold standard is liver biopsy, which has the downside of respecting only a small part of the total lesion volume. Furthermore, this invasive method carries interventional risks like bleeding or infection. Therefore, an image-based biomarker would be highly desirable. Conventional “radiomics” methods have often been utilized for similar problems, but the results are often not reproducible. This is mainly due to sampling errors and interobserver variability, but also the seemingly complex nature of the problem. We present a new approach that implements cutting-edge research in machine learning which is nevertheless cheap and easily applicable in a routine clinical setting. To achieve this, we use convolutional neural networks (CNN) to predict the histopathological findings from liver lesions from preoperative liver CT. Methods: After splitting the study population into a training and test set we trained a CNN to predict the histopathological tumor type from CT data. Results: The developed CNN workflow is able to predict liver tumor histology from routine CT images. We also evaluated in how far transfer learning and data augmentation can help in solving this problem and implemented the developed workflow in a clinical routine setting. Conclusion: We propose a robust semiautomatic end-to-end classification workflow for the prediction of the histopathological type of tumor lesions based on abdominal CT and a deep convolutional neural network model. In our cohort, the model shows reliable and accurate results even with limited computational resources.

Radiofrequency Ablation of Benign Thyroid Nodules.

Benign thyroid nodules are common in the general population with a prevalence estimated to be more than 50% by autopsy studies.[1] [2] They are also a common incidental finding on imaging studies with one prospective study identifying nodules by ultrasound in 67% of patients examined, and are more commonly found in women than in men.[3] Benign thyroid nodules are more common and often more numerous in older patients.[4]

Incidental findings on brain MR imaging of asymptomatic term neonates in the Developing Human Connectome Project.

BackgroundInterpretation of incidental findings on term neonatal MRI brain imaging can be challenging as there is a paucity of published normative data on asymptomatic term neonates. Reporting radiologists and clinicians need to be familiar with these incidental findings to avoid over-investigation and misinterpretation particularly in relation to neurodevelopmental outcome. This study aimed to determine the prevalence of incidental findings in a large group of asymptomatic term neonates participating in the Developing Human Connectome Project (dHCP) who were invited for neurodevelopmental assessment at 18 months.MethodsWe retrospectively reviewed MRI brain scans performed on 500 term neonates enrolled in the dHCP study between 2015 and 2019 with normal clinical examination. We reviewed the results of the Bayley Scales of Infant and Toddler Development (Bayley III) applied to participants who attended for neurodevelopmental follow-up at 18 months. Scores considered “delayed” if <70 on language, cognitive or motor scales.FindingsIncidental findings were observed in 47% of term infants. Acute cerebral infarcts were incidentally noted in five neonates (1%). More common incidental findings included punctate white matter lesions (PWMLs) (12%) and caudothalamic subependymal cysts (10%). The most frequent incidental finding was intracranial haemorrhage (25%), particularly subdural haemorrhage (SDH). SDH and PWMLs were more common in infants delivered with ventouse-assistance versus other delivery methods.Neurodevelopmental results were available on 386/500 (77%). 14 infants had a language score < 70 (2 SD below the mean). Of the 386 infants with neurodevelopmental follow up at 18 months, group differences in motor and language scores between infants with and without incidental findings were not significant (p = 0·17 and p = 0·97 respectively). Group differences in cognitive scores at 18 months between infants with (median (interquartile range) -100 (95–105)) and without (100 (95–110)) incidental findings were of small effect size to suggest clinical significance (Cliff's d = 0·15; p<0·05).InterpretationIncidental findings are relatively common on brain MRI in asymptomatic term neonates, majority are clinically insignificant with normal neurodevelopment at 18 months.FundingThis work was supported by the European Research Council under the European Union's Seventh Framework Programme (FP7/20072013/ERC grant agreement no. [319456] dHCP project), by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z] and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas’ NHS Foundation Trust and King's College London and/or the NIHR Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Malignant melanoma without primary, presenting as solitary pulmonary nodule: a case report

BackgroundSolitary pulmonary nodules are the most common incidental finding on chest imaging. Their management is very well defined by several guidelines, with risk calculators for lung cancer being the gold standard. Solitary intramuscular metastasis combined with a solitary pulmonary nodule from malignant melanoma without a primary site is rare.Case presentationA 57-year-old white male was referred to our lung cancer service with solitary pulmonary nodule. After positron-emission tomography, we performed an ultrasound-guided core needle biopsy of an intramuscular solitary lesion, not identified on computed tomography scan, and diagnosed metastatic malignant melanoma. The solitary pulmonary nodule was resected and also confirmed metastatic melanoma. There was no primary skin lesion. The patient received oral targeted therapy and is disease-free 5 years later.ConclusionsClinicians dealing with solitary pulmonary nodules must remain vigilant for other extrathoracic malignancies even in the absence of obvious past history. Lung metastasectomy may have a role in metastatic malignant melanoma with unknown primary.

Cerebral White Matter Hyperintensities in T2 Weighted Magnetic Resonance Images of Elderly Patients- Correlation with their Mental Status

Background: White matter hyperintensities (WMH), focal and/or diffuse areas of hyperintense signals on T2 weighted magnetic resonance imaging (MRI), are the most common incidental finding in elderly patients. However, their clinical significance is usually overlooked. We aimed to find out the correlation between the degree of cerebral WMH in MRI with the mental status of elderly patients, assessed by Mini-Mental Status Examination (MMSE) score.&#x0D; Methods: This cross-sectional study was conducted for two years on eighty eligible elderly patients (&gt; 60 years) referred to the Department of Radiology and Imaging for MRI of the brain. Demographic variables like age and sex, MMSE score, and MRI variables like location and number of WMHs were studied. The Pearson’s correlation coefficient was used to calculate the correlation between the extent of periventricular WMHs and MMSE score.&#x0D; Results: A significant negative correlation (r = -0.78; p &lt; 0.001) was found between decreased MMSE and the extent of periventricular WMH. A significant negative correlation was also found when periventricular hyperintensities were evaluated individually for frontal caps (r = -0.68; p &lt; 0.0001), band opacities (r = -0.55; p&lt;0.0001) and occipital cap (r = -0.59; p &lt; 0.0001). However, subcortical WMH was not significantly corelated with MMSE score (r = +0.018, p = 0.0897).&#x0D; Conclusion: A significant negative correlation exists between the extent of periventricular WMH seen at brain MRI with cognitive decline in elderly subjects. However, no such correlation exists between subcortical WMH and mental status.

Frequency of Incidental Carcinoma in Thyroids Operated for Multinodular Goiter

Background: Multinodular goiter (MNG) is a common disease in Pakistan. However, malignancy can be found occasionally on histopathological examination of resected goiter specimens. The objective of this study was to determine the frequency of malignant lesions on histopathological examination in thyroid specimens operated for multinodular goiter.Material and Methods: A total of 154 patients undergoing thyroid surgery with preoperative diagnosis of multinodular goiter (MNG) at Al Nafees Medical College and Hospital Islamabad, Pakistan were included in this study. The preoperative diagnosis of MNG was made upon physical examination of thyroid and ultrasound (n=62 cases) and FNAC (n=43 cases) was done in selected cases. Gross examination was done and sections were taken from areas of thyroid with varied appearances including hemorrhagic, solid, firm, white, gray, gelatinous as well as necrotic areas. Qualitative variables, were calculated in terms of percentages and mean and standard deviation were used for quantitative variables.Results: Of the 154 patients with preoperative diagnosis of MNG, there were 139 (90%) female and only 15 (10%) male patients. The age range was 14-60 years with a mean age of 36 ± 10 years The incidence of thyroid carcinoma in patients operated for clinical diagnosis of MNG was 8% (n=12). Papillary thyroid carcinoma was the most frequent type of malignancy (83.3%; n=10). Multifocality (60%; n=6), bilaterality (33.3%; n=4) and left lobe involvement (80%; n=8) of thyroid were more common. Microcarcinoma (measuring 1cm or less) was found in 50% (n=5) of these PTC. Histological type of papillary carcinomas greater than 1 cm were follicular variant (n=3; 30%) and conventional (n=2; 20%) types. The maximum measurement of the tumor was 2 cm. In all cases of PTC, rest of the thyroid showed MNG on histopathology.Conclusions: Incidental finding of thyroid malignancy in clinically diagnosed cases of MNG is not unusual. Papillary carcinoma of thyroid is the most common incidental malignant finding in these cases. Multilocularity in thyroid is not an indicator of benign disease process.

Post-Run T2 Mapping Changes in Knees of Adolescent Basketball Players.

While articular cartilage defects are common incidental findings among adult athletes, the effect of running on the cartilage of adolescent athletes have rarely been assessed. This study aims to assess the variations in the articular cartilage of the knees in healthy adolescent basketball players using quantitative T2 MRI (magnetic resonance imaging). Fifteen adolescent basketball players were recruited (13.8 ± 0.5 years old). Girls were excluded to avoid potential gender-related confounding effects. Players underwent a pre-run MRI scan of both knees. All participants performed a 30-minute run on a treadmill. Within 15 minutes after completion of their run, players underwent a second, post-run MRI scan. Quantitative T2 maps were generated using the echo modulation curve (EMC) algorithm. Pre-run scans and post-run scans were compared using paired t test. Participants finished their 30-minute run with a mean running distance of 5.77 ± 0.42 km. Pre-run scans analysis found statistically significant (P < 0.05) changes in 3 regions of the knee lateral compartment representing the cartilaginous tissue. No differences were found in the knee medial compartment. Post-run analysis showed lower T2 values in the medial compartment compared to the pre-run scans in several weight-bearing regions: femoral condyle central (pre/post mean values of 33.9/32.2 ms, P = 0.020); femoral condyle posterior (38.1/36.8 ms, P = 0.038); and tibial plateau posterior (34.1/31.0 ms, P < 0.001). The lateral regions did not show any significant changes. Running leads to microstructural changes in the articular cartilage in several weight-bearing areas of the medial compartment, both in the femoral and the tibial cartilage.

Painful Os Intermetatarseum: Abnormal MRI imaging findings

Accessory ossicles are a common incidental finding on imaging of the feet. Os intermetatarseum is one such ossicle. These mostly remain asymptomatic; however, pain syndromes associated with accessory ossicles are a known entity and the diagnosis of painful os syndrome should be considered in undifferentiated foot pain. Whilst use of imaging in the diagnosis of painful os syndromes of the foot is well substantiated, there is little available literature on the use of magnetic resonance imaging (MRI) in the diagnosis of painful os intermetatarseum. We report a case of painful os intermetatarseum with MRI findings that have not previously been described

Opportunistic Screening of Patients for Hepatic Steatosis: Clinical Follow-Up and Diagnostic Yield.

Hepatic steatosis is a common incidental finding on abdominal imaging that is not always reported or recognized as having clinical significance. Because of its association with liver disease, cirrhosis, and diabetes, the aim of this study was to bring attention to this finding and provide clinical guidance to referring clinicians by inserting standardized text into radiology reports of patients with incidentally detected hepatic steatosis. Patients with incidentally discovered hepatic steatosis on abdominal ultrasound or CT had standard text inserted into the impression sections of their diagnostic imaging reports. A total of 1,256 patients whose reports were tagged between April 2016 and September 2017 were retrospectively identified and their electronic medical records reviewed to determine subsequent acknowledgment in the medical record or clinical action in response to the tagged report. Information regarding patient demographics, the type of provider who ordered the examination, and the acuity of the examination results was also recorded. Acknowledgment and subsequent clinical action were more likely in patients whose examinations was ordered by primary care providers, whose examination results were not urgent, and who were in the ultrasound group. The overall diagnostic yield in patients who underwent clinical evaluation was nonalcoholic fatty liver disease in 70%, nonalcoholic steatohepatitis in 6%, and alcoholic hepatitis in 17%. Opportunistic screening for incidental hepatic steatosis on abdominal CT and ultrasound is feasible, with substantial yield for patients with clinically important entities including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

An Ectopic Pelvic Kidney

A 46-year-old man presented to the internal medicine department with a 1-year history of abdominal pain. His medical history was non-obstructive hypertrophic cardiomyopathy. Physical examination was unremarkable. As part of the evaluation, computed tomography of abdomen was performed. Focused assessment with computed tomography confirmed no evidence of ascites, but the left kidney could not be identified. A whole-body computed tomography discovered a pelvic left kidney (Figure 1A). Renal function of the patient was normal with a creatinine level of 0.89 mg per deciliter (77 µmol per liter) (normal range, 0.5 to 1.1 mg per deciliter [48 to 90 µmol per liter]). It is a common incidental finding because the affected persons are commonly asymptomatic. Renal ectopia is commonly caused by failure of mature kidney to reach its natural location in renal fossa [1]. The uncommon congenital abnormality was related to the aberrant processes during embryogenesis [2]. Ectopic kidney may be found in pelvic, abdominal, iliac, and thoracic location, among which pelvic ectopia is estimated to occur in 1 of 3000 autopsies [3]. As in this case, the rare condition may become unknown until computed tomography imaging is performed for another reason. Finally, the patient’s abdominal pain was attributed to the duodenal ulcer confirmed by esophagogastroduodenoscopy, and he was treated with a proton pump inhibitor.