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.
Nguyen LT, Sullivan CT, Makam AN. The Diagnostic Cascade of Incidental FindingsA Teachable Moment. JAMA Intern Med. 2015;175(7):1089-1090. doi:10.1001/jamainternmed.2015.1520