Incidentalomas in Paranasal Sinus Computed Tomographic Imaging: Frequency and Characteristics

As patient access to radiology reports increases, incidental findings can be a significant source of stress and an increasing burden for clinicians to address. This study analyzes the frequency and characteristics of incidental findings on paranasal sinus computed tomography (CT) scans.

A retrospective review of a random sample of radiology reports for paranasal sinus CT scans in a metropolitan healthcare system in 2021 was conducted. Incidental findings were defined as unexpected findings which an otolaryngologist would not typically manage or would evaluate using different diagnostic modalities. Incidental findings were categorized based on anatomic location and etiology. Associations between incidental findings with age and sex were examined.

Among 1000 scans, 385 (38.5%) yielded at least 1 incidental finding. Of these, 66% contained 1 incidental finding, 31% had 2 or 3 incidental findings, and 4% had 4 to 6 incidental findings (mean number of incidental findings = 1.5). Among incidental findings, 34.8% were dental-related, followed by 19.9% vascular, 15.3% intracranial, 11.2% unexpected non-sinonasal mass, 7.8% spine, 6.6% otologic/temporal bone, 1.5% orbit/ophthalmologic, 1.4% lymphadenopathy, and 1% thoracic-related. Increasing age was associated with incidental findings (mean age with incidental findings, 59.7 years vs 49.7 years without; P < .001). Sex was not associated with the presence of incidental findings (P = .583). Importantly, 3.4% of findings were considered potentially clinically serious.

Incidental findings are frequently reported on sinus CT scans, though the vast majority are not considered potentially serious. Further refinement of systems for denoting their clinical significance may minimize the burden for clinicians and worry for patients.