Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Background: Incidentalomas—unexpected neoplastic lesions discovered during imaging for unrelated complaints—represent a growing clinical and ethical challenge in emergency medicine. Their detection has increased due to widespread use of advanced imaging, particularly in patients who may otherwise escape thorough diagnostic evaluation.

Objective: We sought to determine the frequency, anatomical distribution, and clinical management gaps of neoplastic incidentalomas  observed in patients presenting with non-specific, low-severity complaints at the emergency department (ED). (In this paper, neoplastic incidentalomas include both lesions discovered incidentally during imaging for unrelated conditions and newly diagnosed malignancies plausibly related to the patient’s presenting symptoms,)

Methods: Data collection covered the period January 1–December 31, 2023. We conducted a retrospective observational study of all adult patients presenting to the ED of P.O. Anastasia Guerriero University Hospital in Marcianise, Italy. Incidentalomas were identified through discharge summaries and classified by imaging modality, anatomical site, and triage code. We analyzed data using descriptive and inferential statistics.

Results: Among 35,081 ED visits, 53 neoplastic incidentalomas were identified (1.52 per 1,000). The majority occurred in females (69%) and elderly (> 65 years) patients (61%), who often presented with minor complaints such as abdominal pain (38%) or anemia (15%). Most incidentalomas were gastrointestinal (31%) or pulmonary (23%) and primarily detected via computed tomography (51%). Notably, 100% of cases were triaged as non-urgent. Based on established guidelines, up to 20% of cases may represent potential overdiagnosis. The next most common modalities of detection were ultrasound (28%) and chest radiograph (22%).

Conclusion: Neoplastic incidentalomas are not rare in the ED setting, even among patients who present with low-severity symptoms. Our findings underscore the importance of structured follow-up protocols and integration of guideline-based reporting to avoid diagnostic delays, overdiagnosis, and unnecessary interventions. Emergency physicians should maintain diagnostic vigilance and consider incidental findings in clinical workflows.