It is not uncommon to come across an incidental benign-appearing or indeterminate lesion on imaging and then wonder what to do next with it. Indeed, there has been an epidemic of thyroid and adrenal nodules which we shouldn’t be doing anything about, thanks to their increased pick-up on imaging. We need to balance the need to avoid excessive imaging with the risk and fear of not missing out an an early malignancy.

The American College of Radiology (ACR), Society of Radiologists in Ultrasound, Fleishner Society, American Thyroid Association, and many other such professional societies have published various guidelines on the appropriate follow-up recommendations/ management of incidentally detected lesions/ observations on a CT/USG. However, it is pretty much an impossible task to remember them all accurately, and to remain updated with their latest version. We provide you with a one-stop resource to guide you to making the correct recommendations on your report.

Click the site of incidentaloma and see the appropriate recommendations in a simple flowchart, sourced directly from the latest guideline, with the link provided if you wish to delve into more details. You can check out the management guidelines available for all 13 incidentaloma sites here, viz.

i. adnexal,

ii. pulmonary,

iii. thyroid,

iv. pancreatic,

v. hepatic,

vi. renal,

vii. adrenal,

viii. gall bladder,

ix. splenic,

x. mediastinal,

xi. nodal,

xii. vascular, and

xiii. pituitary.

The dropdown menu at the top of the blog provides an easy way to go to the appropriate algorithm. Bookmark this page to keep it as a ready resource while reporting, so that you can be confident in your recommendations and quote the appropriate guidelines!

– Akshay Baheti, Tata Memorial Hospital

PS: All images are a copyright of the original published article.