Incidentaloma… One of my favourite words, not my favourite finding.

An incidental finding.

An undiagnosed condition discovered unintentionally that is unrelated to the current medical or psychiatric condition being investigated and/or treated.

Kind of like an accidental finding, but it sounds better.

When I was in Nuc Med, one of my favorite words in medical terminology was “incidentaloma.”   A tumor found by coincidence.  It just struck me funny.  Just like saying “tumour” like Arnold Schwarzenegger.  I even did a scan that turned up an incidentaloma… A parathyroid scan that ended up detecting a right upper outer breast lesion.  That turned out after further assessment to be an early breast cancer.  Pretty exciting stuff for me as an undergrad.  It merited a case write-up.  Not quite as exciting for the patient, but at least it was detected early.

Adrenal incidentaloma. To be further assessed with a triple phase CT. And hopefully turn out to be benign. Image via Disease Disease.

Reading watching the radiologists and residents read scans over the past week has had me thinking about that.  Mainly because there are incidental findings every day.  Most are inconsequential, as you would expect.  Weird little benign growths or malformations that the person wandering around has no idea about and that will likely never give any trouble.  But some are more consequential… More significant.

When one of these little incidental things is found.  One that may be one of several options, the person is often referred for more tests.  Or consultations.  A hypoattenuating area in the liver may be a cyst or a mass or a hemangioma.  An ultrasound can help or a triple phase CT.  Lots of people have chunky adrenal glands… Most are benign, but it could be disease… Triple phase CT again.  Funny nodule in the lung… Let’s rescan in another few months to check for change.  These findings lead to more tests, more questions and more findings.  Often, the diagnosis is cleared up with only minimally more distress for the patient and somewhat more radiation exposure.

Sometimes the little incidental things aren’t so little.  A man with abdominal pain in the ER gets a CT to rule out appendicitis or diverticular disease and he ends up having a very large almost obstructing bowel cancer.  A woman with back pain who turns out to have lesions all over her spine that are likely spread from a cancer.  These lead not only to further tests, but life altering diagnoses.

Suddenly, incidentalomas are not so fun anymore.

I love that in medicine, we have the ability to pick up on things, sometimes early enough to prevent serious disease or at least be able to give some sort of explanation.  But, sometimes being able to see so much isn’t good.  How many people do we see with subtle “likely nothing” abnormalities that get scanned repeatedly, slowly increasing their risk for radiation induced cancers and elevating stress levels, just to say it is nothing.

Surprise! A pelvic kidney. Does it matter? Not usually. But its cool. Image via imageconsult.com

Then comes the question of how much do you tell people?  I am a big pusher of the whole people should be well informed about their health care and their body.  But, do you tell them about the one degenerative asymptomatic disc in their back, the benign nodes in their abdomen that may someday become something, but probably won’t, the cyst in their kidney?  I lean towards yes… But then I think about what difference does that make?  Will the person understand?  Is it really for me to decide?

I don’t have the answers.  I do think it is an individual’s choice how much they want to know and how much they will understand.

Our life is full of incidental findings as well.  Generally, we wander around oblivious to outside circumstances that may impact us.  But sometimes we hear things or learn of things that we probably shouldn’t or wouldn’t have if we weren’t out searching for something else.  Because, realistically, we can’t know everything… Only God does.

But, when we find out one of those odd details, they can change the course we are on… Sometimes for the better, others for the worse… And, at times, they change nothing.  We meet people who were unanticipated, who we did not think were actually going to be important in our lives and they turn out to be glaringly important to us.  We find flaws in ourselves that we never noticed previously that can be corrected.

Incidental findings are the surprises and bumps in the road within our bodies.  Often nothing but a pain in the neck (figuratively) when you have a real pain elsewhere.  But, they can distract us from finding the real underlying problem because they are glaringly obvious in a particular image or because they are more easily assessed.

Just like incidental findings, the incidental things in our lives also can play that game.  A minor surprise or setback can take presidence over the bigger issues at hand.  I know that I am currently dealing with every little thing as opposed to the bigger LMCC because the little things are more apparent and easier to tackle.  I guess we need to remember to manage active problems and assess the minor or less urgent things later.  Easier said than done.

Advertisements

Please, share your thoughts!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s