Incidental Abnormalities Research Articles

Incidental magnetic resonance image sinus abnormalities in asymptomatic Australian children.

Plain X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) scans performed for non-ENT reasons often reveal incidental sinus mucosal changes. These changes need to be correlated clinically before diagnosing rhinosinusitis. This study examined the prevalence of such changes in MRI scans in children up to age 16. Scans were scored using an adapted Lund-Mackay classification and were positive when one or more sinuses showed abnormalities. Randomly selected scans in the retrospective arm revealed a prevalence of 20 of 62 (32.3 per cent). In the prospective arm 45 of 60 children were defined as truly asymptomatic, of which 14 scans (31 per cent) were positive. Other studies in adults and children using CT and MRI report a prevalence range of roughly 30 to 45 per cent. This variability may be attributed to differences of study design, definitions of population age, definitions of asymptomatic and definition of abnormal sinus. Other plausible factors to explain regional differences are climate and frequency of upper respiratory tract infections.

Incidental paranasal sinus imaging abnormalities and the normal Lund score in children

Incidental paranasal sinus imaging abnormalities and the normal Lund score in children

Clinical significance of incidental magnetic resonance image abnormalities in mastoid cavity and middle ear in children

Objective: Magnetic resonance imaging of the head may reveal incidental findings in paranasal sinuses. The purpose of this study was to discover whether similar changes could be identified in the mastoid cavity and middle ear as well. Methods: A group of 50 children undergoing magnetic resonance imaging of the head for suspected intracranial pathology were prospectively gathered. Their parents completed a questionnaire concerning each child's medical history connected with acute otitis media. Otoradiologists evaluated the pictures for mastoid cavity and middle ear and paranasal sinus abnormalities. Results: In six (12%) children, magnetic resonance imaging detected abnormalities resembling acute inflammatory changes, although none had had acute otitis media during the preceding last 3 months. Abnormalities detected in the paranasal sinuses were not correlated with abnormalities in the mastoid cavity and middle ear. Conclusions: High signal intensity in magnetic resonance images from the mastoid cavity and middle ear may be incidental and without any clinical significance. These findings must be interpreted together with knowledge of the child's medical condition and clinical examination of the ears.

Ethical and practical considerations in managing incidental findings in functional magnetic resonance imaging

Functional magnetic resonance imaging has emerged as a powerful tool for mapping the neurologic underpinnings of sensory, motor and cognitive function. Much of this evolution carries assumptions about the subject population under study and, in particular, the neurologic status of subjects entered into studies either as healthy controls or as belonging to a specific disease group. Recent reports of incidental MRI abnormalities in normal volunteers for fMRI studies have brought to attention a variety of practical challenges and ethical dilemmas for researchers, many of whom are not physicians and most of whom have no formal radiological training. We propose a minimum standard for consenting subjects in fMRI protocols, and consider strategies over the longer term that call for expert physician participation, archiving of incidental findings including false positives, and the adoption of guidelines for handling variation in neural activations or performance that appear outside expected norms.

Determination of the “incidental” Lund score for the staging of chronic rhinosinusitis

Objective: Determine normative values for the Lund score for computed tomographic (CT) scans of the paranasal sinuses. Methods: Patients undergoing CT of the paranasal sinus region for nonsinusitis causes were evaluated and staged according to the Lund-MacKay system. Complete and near complete Lund scores were computed from these scans and the frequencies of incidental paranasal abnormalities were tabulated. Results: A total of 199 patients who underwent CT scans of the internal auditory canals, pituitary, or orbits demonstrated adequate visualization of the paranasal sinuses. In 91 patients, the imaging was sufficient to compute a complete Lund score with a mean of 4.26 (95% CI, 3.43 to 5.10). In 130 patients, all sinuses were adequately imaged except for the ostiomeatal complex. For this near complete group, the mean prorated Lund score was 4.26 (95% CI, 3.55 to 4.97). Both of these scores differed significantly from an expected score of zero ( P < 0.001). Conclusions: The Lund score in the general population is not 0. A Lund score ranging from 0 to 5 may be considered within an incidentally “normal” range, and should be factored into clinical decision-making. (Otolaryngol Head Neck Surg 2001;125:483-6.)

Magnetic resonance imaging of the paranasal sinuses: incidental abnormalities and their relationship to patient symptoms.

Magnetic resonance imaging (MRI) is able to demonstrate a wide range of abnormalities in the paranasal sinuses, which are often reported as incidental findings on scans performed for indications other than the evaluation of paranasal sinus pathology. However, the clinical significance of these findings remains undefined. We present a prospective study that determines the prevalence of abnormalities in the paranasal sinuses in a population undergoing MRI scans for suspected intracranial disease. These findings are correlated with clinical data pertaining to nasal and sinus symptoms. Prospective, cross-sectional study. Patients undergoing MRI scans for suspected intracranial pathology were asked to complete a questionnaire pertaining to symptoms of nasal/sinus pathology. The T2-weighted scans of 86 patients (mean age = 51 years) were then reviewed for evidence of paranasal sinus pathology using a standardized method for evaluation and reporting of results. These results were then correlated with those obtained from the patient questionnaire. Radiologic abnormalities were found in the paranasal sinuses of 33 (38%) patients. Abnormalities were most commonly seen in the ethmoid sinuses (44.8%) followed by the maxillary (38%), sphenoid (14%), and frontal (3%) sinuses. Analysis of the clinical data revealed no significant relationship between the presence of clinical symptoms of nasal and sinus pathology and abnormalities on MRI scan. The assessment of inflammatory sinus pathology remains controversial. Based on the results of this study, incidental abnormalities of the paranasal sinuses detected on MRI scan do not appear to be related to clinical symptoms.

7171 Pesky findings on endoscopy or ct scan: endoscopic ultrasound can help.

Endoscopists often encounter submucosal lesions of unknown significance during endoscopy or are asked to evaluate thickened esophageal, stomach or bowel wall noted on CT scan. Endoscopic ultrasound (EUS) has proved useful in defining submucosal and extraluminal structures. The purpose of this study is to determine whether these often incidentally noted abnormalities represent clinically significant entities and to determine whether the addition of EUS changes management or avoids further evaluation. Methods All charts from patients undergoing EUS at Virginia Mason Medical Center between December 1998 and November 1999 were evaluated retrospectively. Patients were included if the procedure was performed because of a nonspecific abnormality seen on endoscopy (thick folds, submucosal nodules or extrinsic compression) or CT scan (thickened gut wall). Patients whose abnormalities were highly suspicious for malignant neoplasm were excluded. Charts were evaluated for patient's age, sex and symptoms which initiated the evaluation. EUS findings and subsequent treatment were noted. Results Of 292 EUS procedures, 33 (11%) were performed because of an ambiguous finding on endoscopy or CT scan. Of these, 10 patients (30%) had clinically significant findings, 4 (12%) of whom had malignant neoplasms (61 y/o female with gastric cancer, 45 y/o female with periappendiceal carcinoid tumor, 45 y/o male and 61 y/o male with gastric leiomyosarcomas). One patient was completely asymptomatic. Other clinically significant findings included small leiomyomas which will require follow up, adenopathy, a prolapsing pancreatic rest and a lymphangiectatic cyst. In all other patients, EUS was able to determine that the abnormality represented a benign process requiring no further evaluation. Findings included lipomas, pancreatic rests, large adjacent vessels causing compression and thicked mucosa due to inflammation without underlying abnormality. Conclusion EUS is useful in evaluating incidental abnormalities found on endoscopy and CT scan. All of the patients could be diagnosed with confidence. Clinically significant findings were seen in 30%, including 12% with malgnant neoplasms. Age, sex and symptoms did not distinguish benign from malignant processes.

Incidental liver abnormalities at laparoscopy for benign gynecologic conditions

To evaluate liver abnormalities among women undergoing laparoscopy for benign gynecologic conditions. Prospective study (Canadian Task Force classification II-2). Tertiary care academic centers. Women undergoing laparoscopy for benign gynecologic indications. The upper abdomen was examined by directing the laparoscope cranially. Incidental liver abnormalities were found in 4.7% of 823 patients. The most common was perihepatic adhesions (Fitz-Hugh-Curtis syndrome), located mainly on the right lobe (66.7%) or on both lobes. Pelvic inflammatory disease was present in one-half of women with perihepatic adhesions. Other abnormalities were consistent with hepatic cirrhosis, adenoma, and hemangioma. Our results suggest the importance of exploring the upper abdomen during laparoscopic surgery.

Prenatal Screening for Toxoplasmosis

Objective: To evaluate the merits of screening for toxoplasmosis in all pregnant women.Methods: We used decision analysis to compare three strategies for the antepartum management of congenital toxoplasmosis: 1) no testing for congenital toxoplasmosis; 2) current practice, which is to perform targeted screening in cases of incidental abnormalities noted on ultrasound; and 3) universal serologic screening of pregnant women followed by amniocentesis to diagnose fetal infection in cases of maternal seroconversion. For each of the three strategies, we considered the two available treatment options: intrauterine antiparasitic treatment or pregnancy termination.Results: Universal screening reduced the total number of cases of congenital toxoplasmosis compared with no testing or targeted screening. However, compared with no testing, universal screening with medical treatment resulted in 18.5 additional pregnancy losses for each case of toxoplasmosis avoided. If infected pregnancies underwent termination, universal screening resulted in 12.1 additional pregnancy losses for each case avoided.Conclusion: Maternal screening reduces the number of cases of disease, but at a substantial clinical cost. The rarity of the disease and limitations in diagnosis and therapy limit the effectiveness of screening strategies. The risks associated with amniocentesis are particularly important. Universal maternal screening for congenital toxoplasmosis should not be performed.

The Characteristics of Bronchioloalveolar Carcinoma Presenting with Solitary Pulmonary Nodule

BACKGROUND: Bronchioloalveolar carcinoma (BAC) has been reported to diveres spectrum of chinical presentations and radiologic patterns. The three representative radiologic patterns are followings; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. While, the localized consolidation and solitary nodular patterns has favorable prognosis, the multicentric of diffuse pattern has worse prognosis regardless of treatment BAC presenting as a solitary pulmonary nodule is often misdiagnosed as other benign disease such as tuberculoma. Therefore it is very important to make proper diagnosis of BAC with solitary nodular pattern, since this pattern of BAC is usually curable with a surgical resection. METHODS: We reviewed the clinical and radiologic features of patients with pathologically-proven BAC with solitary nodular pattern from January 1995 to September 1996 at Samsung Medical Center. RESULTS: Total 11 patients were identified. 6 were men and 5 were women. Age ranged from 37 to 69. Median age was 60. Most patients with BAC with solitary nodular pattern were asymptomatic and were detected by incidental radiologic abnormality. The chest radiograph showed poorly defined opacity or nodule and computed tomography showed consolidation, ground glass appearance, internal bubble-like lucencies, air bronchogram, open bronchus sign, spiculated margin or pleural tag in most patients. The initial diagnosis on chest X-ray were pulmonary tuberculosis in 4 patients, benign nodule in 2 patients and malignant nodule in 5 patients. The FDG-positron emission tomogram was performed in eight patients. The FDG-PET revealed suggestive findings of malignancy in only 3 patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in 1 patient, by CT guided percutaneous needle aspiration in 2 patients, and by lung biopsy via video-assited thoracocopy in 8 patients. Lobectomy was performed in all patients and postoperative pathologic staging were T1N0M0 in 8 patients and T2N0M0 in 3 patients. CONCLUSION: Patients of BAC presenting with solitary nodular pattern were most often asymptomatic and incidentally detected by radiologic abnormality. The chest X-ray showed poorly defined nodule or opacity and these findings were often regarded as benign lesion. If poorly nodule or opacity does not disappear on follow up chest X-ray, computed tomography should be performed. If consolidation, ground glass appearance, open bronchus sign, air bronchogram, internal bubble like lucency, pleural tag or spiculated margin are found on computed tomography, further diagnostic procedures, including open thoracotomy, should be performed to exclude the possiblity of BAC with solitary nodular pattern.

American College of Physicians Guidelines on Cholesterol Screening

Letters15 December 1996American College of Physicians Guidelines on Cholesterol ScreeningAlan M. Garber, MD, PhD, Warren S. Browner, MD, MPH, and Stephen B. Hulley, MD, MPHAlan M. Garber, MD, PhDStanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford, CA 94305.University of California, San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94143.Search for more papers by this author, Warren S. Browner, MD, MPHStanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford, CA 94305.University of California, San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94143.Search for more papers by this author, and Stephen B. Hulley, MD, MPHStanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford, CA 94305.University of California, San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94143.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-12-199612150-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:As Dr. Fronduti surmises, the statement that screening is not recommended for persons 75 years of age and older applies only to primary prevention. The recommendation to do lipid analysis in all persons with known coronary heart disease or other vascular disease applies to men and women of all ages.In many practice settings, as Dr. Goldstein observes, the key issue is what to do with knowledge of a cholesterol level that may have been obtained incidentally as part of a blood chemistry panel. Recognizing that incidental abnormalities discovered in this way may be falsely positive or otherwise ...

Potential cardioembolic sources of stroke in patients less than 60 years of age.

Minor potential cardioembolic sources of stroke such as atrial septal aneurysm or patent foramen ovale are important risk factors for cryptogenic stroke. We aimed to determine the prevalence of these abnormalities through an exhaustive aetiological work-up. One hundred and eighteen stroke patients under 60 years of age, who had no evidence of a significant cardiac source of embolism, were classified into four groups following transoesophageal echocardiography and assessment of cervical arteries. Group A comprised 30 patients (25.4%) who had an arteriopathy, probably related to stroke without any cardiac abnormality; group B, had only a potential cardiac source; group C, nine (7.6%) had an obvious arterial source of stroke and incidental cardiac abnormalities; group D, 30 (25.4%) had neither cardiac or arterial source. Data were analysed with the Chi-square test to compare risk factors between groups, and variance analysis was used to compare age between groups. Significance was assessed as P < 0.05. Fisher's exact test was used to test the association between arterial septal aneurysm and patient foramen ovale. In groups B and D atrial septal aneurysm represented 56.8% of the cardiac abnormalities and was diagnosed in 35.4% of the 79 patients who had an unexplained stroke, and a patent foramen ovale was found in 34.1% of the patients. According to Fisher's exact test, atrial septal aneurysm was significantly associated with patent foramen ovale (P < < 0.001). On this basis, one fourth of the patients might be said to have had a truly cryptogenic stroke as the aetiological work-up failed to demonstrate any source of stroke. Comparison between groups showed that in 23% of the patients in whom an arterial source was detected, there was also a potential cardioembolic source (group C), vs 62% in patients who had no arterial source (groups B and D) (P = 0.0007). Our study confirmed the strong association between atrial septal aneurysm, patent foramen ovale and stroke. Although there was a lower incidence of cardiac risk factors for stroke in patients who had cervical artery disease, we suggest that all patients who have a stroke without evidence of a major cardiac source should undergo transoesophageal echocardiography, in order to ensure a better prevention.

Unsuspected aortic valve vegetation detected during intraoperative transesophageal echocardiographic monitoring for coronary artery bypass grafting

I NTRAOPERATIVE transesophageal echocardiography (TEE) is being used increasingly for monitoring of ventricular function and wall motion during coronary artery bypass grafting (CABG). Although the exact frequency of its use has not been well documented in the literature, a recent survey administered by the Society of Cardiovascular Anesthesiologists at their 1993 Annual Meeting indicated that nearly 39% of the respondents (n = 202) used TEE routinely during cardiac cases (although no distinction was made between CABG and valve surgery).* Although the respondents to this survey represent a biased sample of cardiovascular subspecialists, it appears that the intraoperative use of TEE has become popular. With the use of such a sensitive imagmg modality, the chance of detecting incidental abnormalities unrelated to the primary surgical procedure increases. A case is reported of an unsuspected finding on TEE that led to additional surgical intervention in an already high-risk patient undergoing CABG.

Transesophageal echocardiography in patients less than 60 years of age without obvious cardiac source of embolism

Minor potential cardioembolic sources of stroke such as atrial septal aneurysms (ASA) or patent foramen ovale (PFO) are important risk factors for cryptogenic stroke. We aim to determine the prevalence of these abnormalities through an exhaustive etiological workup including transesophageal echocardiography and cervical arteries assessment in stroke patients younger than 60 years of age who had no evidence of a significant source of embolism. We classified 118 stroke patients into four groups according to transesophageal echocardiography (TEE) and cervical arteries assessment findings. Group A, consisted of 30 (25.4%) patients who had an arteriopathy likely related to stroke without any cardiac abnormality; Group B, 49 (41%) patients who had only a potential cardiac source; Group C, 9 (7.6%) patients who had an obvious arterial source of stroke and incidental cardiac abnormalities, and Group D, 30 (25.4%) patients who had neither cardiac nor arterial source. Data were analysed with X2 test for the comparison of risk factors between groups. Variance analysis was used to compare age between groups. Significance was assessed as p < 0.05. ASA represented 56.8% of the cardiac abnormalities and was diagnosed in 35.4% of the 79 patients who had an unexplained stroke (B and D). A PFO was found in 34.1% of the patients who had a cryptogenic stroke (B and D). According to Fisher's exact test, ASA was significantly associated to PFO (p << 0.001). According to this selection one fourth of the patients might have a truly cryptogenic stroke as the etiological workup failed to demonstrate any source of stroke. Comparison between groups showed that the patients in whom an arterial source was detected also had a potential cardioembolic source in 23% of the cases (C), versus 62% in patients who had no arterial source (B and D) (p = 0.0007). Our study confirmed the strong association between ASA, PFO and stroke. Although there was a lower incidence of minor potential cardioembolic sources in patients who had a cervical artery disease, we suggest a systematic TEE screening in all patients with stroke without major cardiac source, in order to ensure a better prevention.

A prospective analysis of incidental paranasal sinus abnormalities on CT head scans

A prospective analysis of the incidence of paranasal sinus opacification in 100 patients referred for cranial computerized tomography (CT) for non-sinus related problems is described. The findings were correlated with symptomatic assessment. Twenty-seven per cent of asymptomatic patients had sinus opacification. The study illustrates the importance of careful clinical correlation when interpreting CT scans of the paranasal sinuses.

Blinking and the Release Reflexes: Are They Clinically Useful?

To review the clinical utility of blinking and the release reflexes, palmomental, glabellar, grasp, and snout, as an important part of the bedside neurological examination. Articles published from 1966 to 1993 that addressed blinking or the release reflexes were identified by searching the MEDLINE database. Thirty-seven references provided clinically useful and applicable information. There is controversy regarding the optimal method of clinical elicitation of these reflexes. The release reflexes are frequently seen as an incidental abnormality in the elderly. A positive grasp reflex, especially if asymmetrical, is sensitive but not specific for abnormal brain function. Lack of habituation is more important than the mere presence or absence of a reflex. The brainstem circuits involved in the regulation of blinking and the release reflexes are discussed, as are their abnormalities in a variety of clinical settings. Blinking and the release reflexes have clinical utility in the diagnosis and bedside clinical assessment of diseases as diverse as frontal lobe lesions, hydrocephalus, multiple sclerosis, Parkinson's disease, Alzheimer's disease and other dementias, falls in the elderly, ageing, HIV-encephalopathy, schizophrenia, tumors in the region of the sylvian aqueduct and recovery from head trauma.

Pathologic correlates of incidental MRI white matter signal hyperintensities

We related the histopathologic changes associated with incidental white matter signal hyperintensities on MRIs from 11 elderly patients (age range, 52 to 82 years) to a descriptive classification for such abnormalities. Punctate, early confluent, and confluent white matter hyperintensities corresponded to increasing severity of ischemic tissue damage, ranging from mild perivascular alterations to large areas with variable loss of fibers, multiple small cavitations, and marked arteriolosclerosis. Microcystic infarcts and patchy rarefaction of myelin were also characteristic for irregular periventricular high signal intensity. Hyperintense periventricular caps and a smooth halo, however, were of nonischemic origin and constituted areas of demyelination associated with subependymal gliosis and discontinuity of the ependymal lining. Based on these findings, our classification appears to reflect both the different etiologies and severities of incidental MRI signal abnormalities, if it is modified to treat irregular periventricular and confluent deep white matter hyperintensities together.

The diagnosis of sinusitis in infants and children: X-ray, computed tomography, and magnetic resonance imaging: Diagnostic imaging of pediatric sinusitis

Plain film radiographic examination, the historical standard, is rapidly being supplanted by computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of sinusitis. In particular, many endoscopic surgeons consider CT to be a mandatory part of the preoperative evaluation. MRI is useful for cases complicated by orbital or intracranial extension. However, because of considerations of cost, the need for sedation, and for CT radiation exposure, conventional x-ray films will continue to play an important role in the diagnosis and management of medically treated sinus disease. Incidental sinus abnormalities in children without apparent symptoms are usually the result of resolving, uncomplicated upper respiratory tract infection. Opacification, moderate-to-severe mucosal thickening, or air fluid levels in patients with persistent symptoms indicate sinusitis. Sinus imaging in children, whatever the modality, is demanding both in obtaining technically adequate studies and interpreting findings. Poor-quality examinations usually overestimate the presence and severity of disease. Ideally, children should be referred to centers with expertise in pediatric ear, nose, and throat imaging.

The Frequency of Histopathological Abnormalities in Incidental Appendectomy in Urological Patients: The Implications for Incorporation of the Appendix in Urinary Tract Reconstruction

In 1980 Mitrofanoff described the use of the isolated appendix as an intermittent catheterization route to empty a continent urinary reservoir. The procedure was popularized and numerous variations on the same principle were reported. Presence of histopathological abnormalities in the appendix may limit its suitability for reconstructive purposes. We studied the frequency of incidental histopathological abnormalities in appendixes removed electively in 122 urological patients during a radical pelvic operation. The implications for incorporation of the appendix in urinary tract reconstruction are evaluated. A total of 38 patients (31.1%) had notable histological abnormalities of the appendix: 35 had fibrous obliteration of the lumen, 2 had carcinoid tumor and 1 had a mucocele of the appendix. The rate of abnormal appendixes was significantly higher in elderly patients (more than 70 years old). Incidental pathology of the appendix is a frequent finding that may affect the immediate results and the late outcome of urinary tract reconstruction using the appendix. When such strategy of urinary tract reconstruction is considered, potential histopathological abnormalities should be anticipated. The patients should be informed and aware of possible unexpected changes in the preplanned procedure, while the surgeon must be familiar with these alternative reconstructive methods.

MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms

Magnetic resonance imaging is able to demonstrate a wide range of sinus abnormalities. Incidental findings in patients referred for neuroradiology because of suspected intracranial pathology are surprisingly common and were present in 37.5 per cent of 483 images examined. The maxillary and ethmoid sinuses were most commonly affected with 27 and 26 per cent of images abnormal whereas the frontal and sphenoid sinuses were less commonly affected with 5 per cent of each abnormal. If minor changes were excluded then 17 per cent of patients had either fluid, a polyp or marked mucosal thickening in at least one sinus. Nasal symptoms, other than the presence of a cold, showed no statistically significant relationship to abnormal findings. Many people with inflammatory changes in their sinuses demonstrated on MRI do not have symptoms classically attributed to sinusitis.