Posted by: notdeaddinosaur | March 13, 2015

Explaining the Unexpected

Incidentaloma: a cutesy term for an unexpected finding on an imaging or lab study unrelated to the study’s original purpose.

Known more formally as an “incidental finding”, they are a huge source of wasted time, money, effort, anxiety, and medical resources spent tracking down exactly what they are. Because lawsuit!

I found myself trying to explain this concept to a patient the other day, and came up with this:

It’s something completely unrelated that’s photobombing your xray.

Isn’t that exactly it?

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Responses

  1. I don’t understand. If it’s a bad thing, wouldn’t you want to get to the bottom of it anyway? Even if it has nothing to do with the thing you were looking for in the first place?

  2. It’s so rarely a “bad thing” that no, as a rule, it’s not worth getting to the bottom of. You can spend so much time and money chasing down so many “nothings” that you don’t have anything left (appointments, MRI slots, etc) to work up the truly worrisome findings. Also, ever hear of “overdiagnosis”? It means finding “bad things” that are so small or slow-growing that dealing with them early doesn’t change the ultimate outcome (for better or for worse).

  3. Brava on your comment above, Dr. Dino!

  4. Frequently found on travelling “screenings” you know the ones that offer 5 screens for $100.

  5. Sometimes incidental findings are not a huge waste of time. Mine was kidney cancer…

  6. Sometimes you do find something important, and that’s terrific. It’s trickier when you’re told that a clever new tool has found something [say, map-dot dystrophy on your cornea] that an enthusiastic man with a laser is very keen on fixing for you [by abrading the cornea further, with the assurance “it will grow back smooth”]. It’s hard, in the absence of clinical trials, or data on long-term outcomes, to tell whether you have a genuine problem, or an MD with a tool he’d really like a chance to use.


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