Hall William B, Truitt Sherstin G, Scheunemann Leslie P, Shah Sidharth A, Rivera M Patricia, Parker Leonard A, Carson Shannon S
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.
Arch Intern Med. 2009 Nov 23;169(21):1961-5. doi: 10.1001/archinternmed.2009.360.
Chest 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.
In 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.
Pulmonary 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.
The 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.
在急诊科，胸部计算机断层血管造影（CTA）常用于评估疑似肺栓塞（PE），但常发现非PE的结果。我们的目的是确定为评估PE而进行的胸部CTA上偶然发现的患病率及其管理意义。
在一项横断面研究中，我们回顾了一家三级医院急诊科开出的589例肺部CTA。我们测量了PE的患病率，并将其他发现分为以下3类：（1）为急性症状提供潜在替代解释的发现；（2）需要临床或放射学随访的偶然发现；（3）需要不太紧急或无需随访的其他发现。我们回顾了所有新诊断的肺结节和显著的胸内淋巴结肿大，并确定了标准推荐的临床随访。
589例CTA中有55例（9%）发现肺栓塞。共有195例CTA（33%）有支持替代诊断的发现。共有141例患者（24%）有需要诊断随访的新的偶然发现，包括73例（13%）有新的肺结节和51例（9%）有新的淋巴结肿大。根据当前临床指南，96%有新的偶然肺结节的患者建议进行随访计算机断层扫描或其他检查。
在急诊科进行的CTA发现偶然肺结节或淋巴结肿大的可能性是发现PE的两倍多。应制定系统方法，以帮助初级保健医生应对越来越多具有临床相关性的偶然放射学发现。
