The Overlooked Red Flag: Why Secondary Findings in Imaging Studies Deserve Serious Attention

Incidental or secondary imaging findings can often be an early indication of a potentially serious health condition. Overlooking these findings can lead to delayed care that can dramatically impact healthcare outcomes. The lack of follow up on these findings is a leading cause of medical malpractice claims.

Introduction: In modern healthcare, diagnostic imaging is a cornerstone of accurate diagnosis and timely intervention. CT scans, MRIs, ultrasounds, and X-rays guide decisions across nearly every medical specialty. But while these studies often reveal the cause of a patient's immediate concern, they can also uncover secondary findings, unexpected abnormalities or incidental findings unrelated to the primary reason the imaging was ordered.

Unfortunately, these secondary findings are frequently overlooked, under-communicated, or ignored, a dangerous oversight that can have devastating consequences. When early signs of disease are not addressed because they were "incidental," patients may face delayed diagnoses, limited treatment options, and worsened outcomes that might have been avoided.

What Are Secondary Findings in Imaging? Secondary findings—sometimes referred to as incidental findings—are unexpected results discovered during an imaging study performed for a different reason. Examples include:

• A chest CT for cough that reveals a thyroid mass

• An abdominal CT for kidney stones that detects a liver lesion

• A brain MRI for headaches that picks up a pituitary tumor

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While the primary finding addresses the patient's immediate concern, these secondary findings may represent early signs of serious illness, including cancer, aneurysms, or infections. When follow-up is required and doesn't happen, the consequences can be tragic.

The Silent Problem: Why Secondary Findings Fall Through the Cracks

1. Primary Focus Bias Radiology reports often emphasize findings relevant to the clinical question. A radiologist may briefly mention a secondary concern deep in the report, which providers may overlook.

2. Communication Breakdown No single provider is responsible for acting on a secondary finding. Without clear communication or designated ownership, necessary follow-up actions are missed.

3. Lack of Protocols and Accountability Many healthcare organizations lack standardized workflows for managing incidental findings, leading to confusion and inaction.

4. EMR Overload In today’s EMR systems, imaging results may be buried in a flood of daily alerts. Important findings are easily missed.

The Role of Subspecialized Radiologists

Not all radiologists are created equal. Some hospitals or clinics use general radiologists for all scans, while others have subspecialized experts in areas like:

• Neuroradiology

• Musculoskeletal imaging

• Cardiothoracic imaging

• Abdominal radiology

• Breast imaging

  
  

If your imaging center lacks access to these subspecialists, you are well within your rights to ask for a referral for a subspecialist read, particularly if your scan involves areas outside of the main concern. As you read your imaging report and discuss with your doctor, be sure to ask for an expert to review.

Additionally, many most hospitals don’t have radiologists covering nights and weekends. Organizations contract with companies to read imaging. Residents may provide a read and then the images are overread the next day. Be sure to get the final read. Sometimes you can have imaging reported with negative findings only to have positive findings on an over-read.

The Consequences: Missed Diagnoses, Delays in Care, and Malpractice

When secondary findings are missed or not followed up on, the clinical implications can be severe. For example, a stage I lung cancer seen on a scan could progress to stage IV in six months, shifting prognosis from a >70% five-year survival rate to <10%.

Legal and Financial Implications Missed secondary findings are a common basis for medical malpractice claims involving:

• Failure to follow up

• Failure to diagnose

• Delay in care

Examples:

• $5 million verdict for missed kidney mass on MRI

• $2.5 million settlement for missed lung nodule on spine CT

• Missed thyroid nodule leading to advanced cancer diagnosis and lawsuit

What Patients Can Do: Advocate, Read, Ask

1. Read the Radiology Report Access and read the full imaging report, not just the summary. Look for terms like "incidental finding" or "recommend follow-up."

2. Ask Your Doctor About All Findings Prompt your provider by asking, "Were there any other findings besides what we were looking for?"

3. Get a Second Opinion (Over-Read) Ask for the imaging to be reviewed by a board-certified or subspecialist radiologist, especially if the secondary finding involves a specialized area.

The Role of EvaluCare and Other Review Services

Organizations like EvaluCare offer expert review of medical records. Practicing quality and medical professionals have extensive knowledge of practice guidelines related to follow up. Their services can:

• Analyze delays and missed follow-ups

• Identify standard-of-care violations

• Help families understand what went wrong and what should have happened

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These reviews can support legal claims or provide closure and clarity to help hold organizations accountable for thorough follow up. One of the best ways to improve our healthcare system is to hold our providers and health systems accountable for poor care management related to the. lack of follow up and timely care.

Case Study: A Preventable Delay in Care

A 52-year-old woman had a CT scan for abdominal pain. It showed diverticulitis and an incidental 3 cm ovarian mass. No follow-up was scheduled. Six months later, she was diagnosed with stage III ovarian cancer. A malpractice suit awarded her $3.2 million for the preventable delay.

How the System Should Work: A Call for Standardization

Healthcare systems must adopt structured and accountable processes:

• Standardized reporting language

• EMR alerts and tracking for secondary findings

• Assigned ownership for follow-up

• Patient notification in layman's terms

• Audits to ensure compliance

  
  

Conclusion: Secondary Findings Deserve Primary Attention

Secondary findings are not secondary in importance. They often represent the first warning signs of disease. Yet due to systemic gaps, they are frequently missed. Patients must advocate for clarity, providers must take ownership, and healthcare systems must implement safeguards.

Organizations like EvaluCare offer crucial support in identifying and addressing these oversights. Lives depend on early detection. We must ensure that no red flag goes unnoticed. The next live we might save is yours or a family member.

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EvaluCare provides medical care review services for patients, families and attorneys. We are a dedicated and trusted team of practicing medical professionals. If you have concerns about the care you, a loved one or a client received, EvaluCare can arm victims with the knowledge they need to get the settlements they deserve. If you or a loved one needs medical care reviewed, email info@EvaluCare.net or visit EvaluCare.net