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Teachable Moment
July 2015

The Diagnostic Cascade of Incidental FindingsA Teachable Moment

Author Affiliations
  • 1University of Texas Southwestern Medical School, Dallas
  • 2Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas
JAMA Intern Med. 2015;175(7):1089-1090. doi:10.1001/jamainternmed.2015.1520

A frail 76-year-old woman from Mexico presented for follow-up of computed tomography (CT) angiography. She weighed 85 pounds, had stage 4 chronic obstructive pulmonary disease (COPD), which she managed at home with 2 liters of oxygen, and a history of tuberculosis (TB) 14 years earlier. One year prior to presentation, an asymptomatic right carotid body tumor had been incidentally discovered during CT angiography intended to evaluate a possible vertebral artery stroke. The biochemical workup of the tumor at that time was consistent with a benign nonsecretory paraganglioma of her neck. A decision was made to observe the tumor with a 1-year surveillance CT scan, the reason for her present visit. The follow-up scan showed no significant increase in tumor size but did reveal new right upper lobe lung nodules. She was admitted to the hospital for workup of this second incidental finding.

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