Core IM | Internal Medicine Podcast #111 Discharges with Incidental Findings: Gray Matters Segment
Sep 21, 2022
Explore the complexities of incidental findings, especially lung nodules discovered via CT scans. Learn how to assess when these nodules require inpatient or outpatient follow-up. The discussion also highlights the innovative concept of 'fast forward rounds' to improve outpatient care. Delve into effective communication strategies for discharge summaries and the importance of collaboration with primary care providers. Navigate the challenges of creating robust follow-up plans to enhance patient safety and avoid oversights in care.
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Missed Lung Nodule
- Jason Fried recalls a case of a 72-year-old Vietnamese woman admitted for pancreatitis.
- An incidental 2.5 cm lung nodule, found on a chest X-ray, was almost missed during her discharge.
Lung Nodule Prevalence
- Incidental lung nodules are surprisingly common, appearing in ~30% of chest CTs.
- This translates to 1.6 million new cases annually in the US, comparable to new diabetes diagnoses.
Nodule Size and Management
- For lung nodules ≤8mm, surveillance is usually sufficient, as cancer risk is ≤1%.
- Larger nodules require more complex evaluation, possibly using risk prediction tools.