Incidental Findings in Radiology

As a medical malpractice lawyer, I have reviewed hundreds and hundreds (maybe thousands) of cases involving different types of imaging: CT scans, MRIs, KUBs, PET scans, sonograms, and x-rays.  In the context of a delayed diagnosis case, it can be important to have films reviewed by a board-certified radiologist or neuroradiologist to determine whether they were originally read correctly.

 Radiologists are required to review the entire field of the film and report any findings that are considered abnormal. Occasionally, a radiologist will find an “incidental” finding that was not the subject of the original reason for the radiological study. For example, in a patient with acute abdominal pain, a CT scan might be obtained in order to evaluate whether the patient has internal bleeding, perforation of an organ, appendicitis or a gallbladder attack. The abdominal CT will also obtain images of the lower portion of the lungs. In some patients, who are suffering from undiagnosed lung cancer, a lung tumor or nodule will appear incidentally on the abdominal CT image. The radiologist has a duty to review those portions of the film that appear on the images, including the lower portion of the lung. When the lower portion of the lung reveals a tumor or other suspicious abnormality, the radiologist has a duty to note that on the official reading of the film.

In addition to noting all abnormalities present on the radiology field, a radiologist has a duty to report significant abnormalities in a specific way. The American College of Radiology (ACR) sets forth guidelines for reporting abnormal findings. When the result is considered to be critical, the radiologist must note that in his or her radiology report. However, there is an additional requirement. The radiologist is required to specifically report critical abnormal findings verbally to the ordering physician. In this way, important information that is critical to the patient’s health and safety does not fall through the cracks.

Incidental findings that are not reported by a reviewing radiologist may not come to light for many months or years after the original film is taken. Later, usually, when the patient becomes symptomatic, additional imaging is taken. The standard practice is for a radiologist to compare new imaging with prior imaging. It is appropriate for the radiologist to report that an abnormality seen on a current film was also present, but smaller, on an earlier film. The attending physician owes a responsibility to the patient to inform them that the incidental finding from the earlier film was missed or not properly reported.

The failure to identify or properly report incidental findings may serve as a basis for a medical malpractice case arising out of the delayed diagnosis of cancer. If you or a loved one has experienced a delayed diagnosis of cancer or wrongful death related to a delay in diagnosis, you should contact an experienced medical malpractice lawyer, such as from Mishkind Kulwicki Law Co, LPA, as soon as possible in order to explore your legal rights.