Incidentalomas and Medical Malpractice

 Medical malpractice comes in many flavors, including nursing errors and omissions, negligent hospitals, pharmacy errors, medication mix-ups, forgotten lab results, busy doctors entering wrong orders for the wrong patient, wrong site surgery, surgical errors, medical mistakes by inexperienced residents, and so on. It can be hard for a medical malpractice lawyer to keep track. 

 One area that resurfaces from time to time is a radiologist’s failure to identify or report an incidentaloma. Incidentalomas are radiological abnormalities that show up on CAT scans, x-rays, MRIs, or ultrasounds that are not the subject of the scan, but appear incidentally. For example, if an abdominal CT scan is ordered to evaluate a patient’s upper quadrant pain shows a large nodule in the lower lobe of the patient’s lung, this incidental finding is called an incidentaloma.

 The prevalence of incidentalomas ranges from 2.7% to 43% depending upon the type of imaging, patient age, and skill of the radiologist. Not all incidentalomas require follow up. For example, tiny lung nodules are not deemed significant. However, all incidentalomas should be reported in the official radiology report. In addition, if the incidentaloma is “critical,” meaning representative of a significant abnormality, the radiologist has a responsibility to verbally make the ordering physician aware of the finding, in addition to reporting it in the official report. 

 Over-reporting of incidentalomas can also raise a problem in terms of unnecessary procedures and expensive tests. In 2017, 36 million MRI scans were performed in the U.S. At that rate, given the prevalence of incidental findings, the American College of Radiology (ACR) formed a task force to develop evidence based strategies for follow up on incidental findings.

 To date, the ACR has addressed incidental findings on abdominal and pelvic CT and MRI scans for the following topics: adrenal gland, vascular, spleen, lymph nodes, gallbladder, thyroid, liver, pancreas, kidney masses, the pituitary gland and the chest (thoracic). A recent book, Theime, Incidental Findings in Neuroimaging and their Management, addresses incidental findings on brain imaging. With the exception of pituitary gland masses, the ACR has not yet addressed this important area. 

Skilled lawyers, like medical negligence lawyers from Mishkind Kulwicki Law Co, L.P.A., know that it is important to keep updated on the ACR’s progress in evaluating the appropriate management of incidentalomas. With improving imaging techniques, the rate of incidental findings is bound to increase, resulting in many opportunities to find cancerous and infectious masses early on. With both cancer and infection, early diagnosis is critical to prompt and thorough treatment at an early, curable stage. A delay in diagnosis or a delayed treatment can result in progression of cancer to an advanced or terminal stage that is incurable. Likewise, delayed diagnosis or a delay in treatment of infection can result in progression of an early local infection to sepsis, septic shock, multiorgan failure, and death. The topic of incidentalomas will continue to be a source of interest to medical malpractice attorneys and radiologists for the indefinite future.