Incidental findings on cervical spine computed tomography scans: overlooked and unimportant?

Imaging of the cervical spine for trauma or degenerative disease includes multiple areas of the head and neck that may harbor incidental findings. We sought to determine the incidence of common "incidentalomas" on cervical spine CT scans, their importance, and how often these lesions are mentioned in reports.

We retrospectively reviewed the cervical spine CTs and reports of all patients scanned between October 2017 and January 2018 for Tornwaldt cysts (TC), thyroglossal duct cysts and remnants (TGDC), laryngoceles (LC), pharyngoceles (PC), carotid artery calcified stenosis (CACS), and aberrant right subclavian arteries (ARSA). Descriptive statistics were performed, and the incidence of cancers (in PC and LCs) and strokes (in high-grade carotid stenosis) was assessed.

Among 2116 patients, the incidences of findings were TC 6.6% (138/2100), TGDC 6.3% (122/1770), LC 9.4% (197/2100), PC 6.4% (135/2100), CACS 4.7% (100/2114), and ARSA 0.86% (18/2097). Of the 2116 patients studied, 600/2116 (28.3%) had at least one incidental finding. Only 2.9% (20/701) of incidentalomas were mentioned in the official reports.

Cervical incidentalomas vary in rates from ARSA (0.86%) to LC (9.4%). They are rarely mentioned in radiologists' reports. Whether improved vigilance and reporting of these incidentalomas would benefit patient care should be explored.