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Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
How would you approach a patient with a splenic cyst?Cystic lesions of the spleen are increasingly common entities. The vast majority are incidental findings on cross-sectional imaging that has been performed for other indications.Surgical intervention is determined by cyst size and symptoms.Small, asymptomatic cysts with no suspicious radiological features can be left alone and observed.Cysts >5 cm in size are at higher risk of rupture and intervention is indicated.Options include percutaneous drainage / alcohol ablation (both have high risks of recurrence, do not provide definitive histology and may result in infection of the cyst) or splenectomy.If parasitic cyst (most commonly echinococcal in origin), percutaneous interventions are contraindicated. Spillage of cyst contents must be avoided both pre- and intraoperatively to prevent life-threatening anaphylactic reactions.
Persistent Physical Symptoms
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
Consideration of onward referrals, or triggers for referrals, e.g. change in symptoms, should be factored into the patient care plan. A balance needs to be struck between the significant risk of over investigation, such as direct complications, incidental findings, false positives or reinforcing unhelpful health beliefs, and that of missing a major pathology [37]. No one will ever get this totally right and recognising and acknowledging this is hugely powerful, as is sharing your own concerns and uncertainty openly with the individual – the optimal outcome is collaboration even in the face of major unknowns [38].
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
3D display may also facilitate the assessment of the presence, extent and location of LV perfusion abnormalities. Incidental findings from the CT should be considered, to determine if they are relevant to patient management.
More-Than-Partial Entrustment in Pragmatic Clinical Trials
Published in The American Journal of Bioethics, 2023
Once the incidental finding is communicated to the relevant patient, we are back in the clinical setting that is the home of the strong, relatively full entrustment that is its hallmark—albeit a feature qualified by the vagaries of health insurance. That is, what should clinically be done about the stroke or osteoporosis risk, once it has been communicated to the patient, becomes a matter of ordinary clinical care. As Morain and Largent put it, “if patients really need care, their clinicians should provide it, and their insurers should cover it” (15). But in the case of incidental findings, this cannot be done unless those who discover them see to it that the clinicians and their patients are apprised of them. As I have argued, the partial-entrustment case for the research team to return significant and actionable incidental findings is even stronger in the case of PCTs than in the case of explanatory studies because the entrustment obligations arising from PCTs ultimately derive from clinicians’ full responsibilities to their patients.
Prevalence and outcomes of interstitial lung abnormalities in a Canadian lung cancer screening trial
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2023
Katelyn Stuart, Marwa Ahmad, Stacey D. Lok, Ashley-Mae Gillson, Eric L.R. Bédard, Alain Tremblay, Kerri A. Johannson
The Alberta Lung Cancer Screening trial was a 5-year cohort study in which high risk individuals underwent three annual low-dose CT (LDCT) scans with several research endpoints.6–8 Alberta is a Canadian province with a population of approximately 4.5 million individuals, and 3.8 million adults. Patients were recruited through social and traditional media events and targeted paid social media advertising. Individuals aged 55-79 with a PLCOm2012 risk score ≥1.5% or with ≥30 pack-year smoking history and having quit ≤15 years prior were eligible for enrollment. Designated thoracic radiologists reported on CT findings with prioritized focus on findings suggestive of lung malignancy, and incidental findings in a dedicated electronic synoptic report.9 Incidental findings were reported at the discretion of the radiologist, specifying if each finding was significant, needing further evaluation. This was communicated to both the subject’s primary care provider and the subject.
Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report
Published in Physiotherapy Theory and Practice, 2022
Fabrizio Brindisino, Firas Mourad, Filippo Maselli
EF of the scapula is a rare, ill-defined, pseudo-tumoral lesion of the soft tissues. Its characteristic location and its specific aspect in imaging studies most often provide the diagnosis following an incidental finding. Nevertheless, referral for a further expert opinion and medical consultation is needed to rule out a malignant cancer diagnosis. Even in patients with shoulder pain who have a musculoskeletal diagnosis, the red flag must be inquired, examined, and evaluated in detail. Ultrasonography should be recommended, especially when obtained during the evaluation are similar to the ones described in this case report. Awareness of this diagnosis by PT may also mean that the patient can avoid the need for further diagnostic procedures, delayed diagnosis and expensive and unnecessary rehabilitation procedures.