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SINGLE CERVICAL SPINE SCOUT IMAGE INCIDENTALLY REVEALS LUNG ADENOCARCINOMA

2020; Elsevier BV; Volume: 158; Issue: 4 Linguagem: Inglês

10.1016/j.chest.2020.09.129

1931-3543

Alex Chen, Rohit Munagala, Atul Lodh, Kate Stanitski, Jayanth Keshavamurthy,

Radiology practices and education

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Scout views are preliminary images typically utilized as a reference for the final imaging series. While scout views are not the primary interest of the study, recent cases have shown that radiologists are responsible for any visible pathology. As the following case of an incidental pulmonary nodule found in a single scout image of the cervical spine demonstrates, reviewing scout images can improve patient outcomes and protect physicians from liability. CASE PRESENTATION: A 62-year-old male was incidentally found to have a 1.5 cm apical pulmonary nodule on a single scout image of a cervical spine MRI as a follow up for degenerative changes seen on x-ray. Follow up CT of the thorax and PET-CT found a spiculated nodule in the right apex measuring 1.8 x 1.6 x 1.5 cm suspicious for malignancy and a 1.4 x 1.5 x 13 mm perivascular nodule in the right upper lobe with no evidence of distant metastases. Biopsy revealed the nodule was TTF-1 positive and P40 negative consistent with primary lung adenocarcinoma. The patient was referred for a right upper lung lobe lobectomy and the final pathology report confirmed stage IIB adenocarcinoma with two foci as well as the involvement of one of the peribronchial lymph nodes. The patient has completed chemotherapy and is in remission so far. DISCUSSION: MRI scout views may reveal pathologic findings that are not visualized on the field of view study. These images are often overlooked, but recent cases have shown that radiologists are legally liable for scout image findings. The specific finding of a pulmonary nodule may significantly reduce patient morbidity and mortality. It is estimated that 1.5 million Americans have a pulmonary nodule found annually, of which 63,000 will receive a new diagnosis of lung cancer within the next two years. Localized lung cancer disease has a five-year survival rate of 50%. However, over 50% of lung cancers are diagnosed with distant metastases, which has a five-year survival rate of 3.6%. Due to the tendency for lung cancer to be silent and to present late in the disease course, the presence of a pulmonary nodule on MRI should be followed up with a CT scan to confirm the size and morphology of the nodule. The Fleischner Society guidelines recommend PET/CT, biopsy, or resection of all nodules with suspicious morphology or larger than 8 mm in diameter on CT. CONCLUSIONS: Scout views are images utilized as a reference for the final imaging series. This case highlights how reviewing these images and proper follow-up for their findings leads to better outcomes for patients and fewer lawsuits for physicians. Reference #1: Gould MK, Tang T, Liu IL, Lee J, Zheng C, Danforth KN, Kosco AE, Di Fiore JL, Suh DE. Recent Trends in the Identification of Incidental Pulmonary Nodules. Am J Respir Crit Care Med. 2015 Nov 15;192(10):1208-14 Reference #2: Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med. 2011;32(4):605–644 Reference #3: Daffner RH. Reviewing CT Scout Images: Observations of an Expert Witness. American Journal of Roentgenology. 2015;205: 589-591. DISCLOSURES: No relevant relationships by Alex Chen, source=Web Response No relevant relationships by jayanth keshavamurthy, source=Web Response No relevant relationships by Atul Lodh, source=Web Response No relevant relationships by Rohit Munagala, source=Web Response Consultant relationship with Imagen Technologies Please note: $1001 - $5000 Added 03/26/2020 by Kate Stanitski, source=Web Response, value=Salary