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Significance of an Incidentaloma in chest – our experience

Significance of an Incidentaloma in chest – our experience. DR ANIL (Resident – DNB General Surgery) DR H.V. RAJA SHEKARA REDDY (Consultant – Thoracic Surgery). INCIDENTALOMA - WHAT IT IS ?. Definition :-

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Significance of an Incidentaloma in chest – our experience

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  1. Significance of an Incidentaloma in chest – our experience DR ANIL (Resident – DNB General Surgery) DR H.V. RAJA SHEKARA REDDY (Consultant – Thoracic Surgery)

  2. INCIDENTALOMA - WHAT IT IS ? Definition :- Tumor found by coincidence (incidentally) without clinical symptoms or suspicion . • Definition excludes :- • Patients undergoing imaging procedures as a part of staging & workup for cancer.  • With increase of “whole – body CT scanning “ as a part of screening programs – incidence of incidentaloma expected to increase. • 37% patients receiving whole body CT scan may have abnormal findings which need further evaluation.

  3. incidences • Up to 20-50% of mediastinaltumors are detected incidentally. • Most of the Solitary Pulmonary Nodules are incidentally detected ( 0.2% of chest X-rays images). • According to the American Cancer Society, lifetime odds to develop lung cancer – • 1 in 13 – men • 1 in 16 – woman • Of these between 20% and 30% will present as an Solitary Pulmonary Nodule. • Master Health Check up at patient request

  4. Carefully studied routine investigations – probably essential to pick some life threatening conditions at early ( probably curable ) stage .

  5. HOW WE DETECTED…. • Study period :- February 2008 to July 2013 • We reviewed the record of the patients retrospectively. • Asymptomatic and Routine Master Health Checkup • As part of pre employment • As part of requirement for VISA • Symptoms – non specific

  6. TOTAL NUMBER OF PATIENTS WITH DETECTED INCIDENTALOMAS - 23 • MEDIASTINAL INCIDENTALOMAS – 16 • LUNG INCIDENTALOMAS – 7 (7) (2) (7) (2) (7) (7) RIGHT LUNG (3) LEFT LUNG (4)

  7. Asymptomatic and Routine MHC • 55Y/F • Husband admitted for hemorrhoid surgery • Easy Fatigability noted by family members, no chest symptoms • MHC

  8. Diagnosed with right sided thymoma with cyst

  9. VATS with Aspiration of Cyst , Excision and Thymectomy Histopathology Thymic Cyst

  10. Symptoms – non specific • 45y/M • Fever 2 months • On ATT for 1.5 months • No relief • Generalized itching of 1 month • LFT – N • CXR & CT mediastinal nodes • Mediastinoscopy – Hodgkin’s lymphoma

  11. Symptoms – non specific • 40/F – abdominal discomfort

  12. Bronchoscopy – no endobronchial lesion • CT guided biopsy – not possible • On table frozen section – malignancy • Pneumonectomy with lymphadenectomy • NSCLC – Moderately differentiated squamous carcinoma • T2N2M0

  13. As part of Pre Employment MHC 32y/M with Occasional fever Large Dermoid cyst on left pericardium

  14. Routine investigation for other cause

  15. SIGNIFICANCE OF DETECTING AND ??? MANAGEMENT • For Patients :- • Potentially lethal conditions can be diagnosed early. • Can be treated with curative intent • Decreases the morbidity • Improves outcome and survival. • For Doctors :- • Medico –Legal consequences

  16. What do I mean ? • Medico – Legal consequences …… • A 44-year-old female received a routine chest X-ray prior to hernia surgery; an incidental finding of a lung nodule was not reviewed by the ordering clinician, and was never followed up, resulting in a delayed cancer diagnosis and a poor prognosis

  17. Allegation • The patient’s estate sued the surgical resident and the hospital, alleging that negligent failure to act upon an abnormal chest X-ray resulted in a three-year delay in diagnosing the cancer. The suit claimed that the delay allowed a potentially very treatable/curable cancer to advance to a terminal stage for this patient. • Disposition • This case settled for more than $2 million against the hospital and the surgical resident.

  18. Conclusion • Routine full body health check up’s may not necessarily be unnecessary. • Even the tiniest of the lesion can be devastating if not addressed appropriately

  19. REFRENCES • Telles A C, Mendoza D . Relevance of an incidental chest finding. Lung India. 2012 ; 29(1): 50–52. • MacMahon H, John H M , Herold C J et al. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005 ; 237(2): 395-400. • LaValley D. Incidental Finding on Routine X-ray Not Pursued By Radiologist or Ordering MD. 2011. • Christian S. A mediastinal mass. The Journal of Family Practice. 2010 ; 59(6): 347-350.

  20. Thank you

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