{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:47:53Z","timestamp":1782784073500,"version":"3.54.5"},"reference-count":23,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"JSPS KAKENHI","doi-asserted-by":"publisher","award":["22H03177"],"award-info":[{"award-number":["22H03177"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"JSPS KAKENHI","doi-asserted-by":"publisher","award":["23K24436"],"award-info":[{"award-number":["23K24436"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Incidental malignancies on emergency department (ED) CT may go unrecognized, risking delayed diagnosis. We investigated their prevalence, recognition rate, and follow-up risk stratification. Methods: We retrospectively reviewed 15,347 CT reports from a tertiary ED (April 2016\u2013March 2019). To determine whether missed diagnoses reflected inherent radiological difficulty or situational factors, ten board-certified emergency physicians completed a standardized 18-case interpretation test under off-duty conditions. Results: Incidental malignancies were identified in 25 patients (0.16%); lung carcinoma was most common (28%). Of 25 patients, 16 (64%) had malignancy recognized at the initial ED visit; 9 (36%) were missed. One discharged new patient without scheduled follow-up represented the highest-risk group for loss to follow-up. Diagnostic accuracy ranged from 0\/10 to 9\/10 (Cochran\u2019s Q test, p &lt; 0.001). Cases 1, 4, and 7 were unidentified by all evaluators (p = 0.002 vs. Case 16, McNemar test with Bonferroni correction). No significant inter-physician difference was observed (p = 0.73, Friedman test). Conclusions: Incidental malignancies occurred in 0.16% of ED CT examinations, with 36% missed at initial presentation. Missed diagnoses reflected inherent radiological difficulty and systemic factors rather than individual expertise. Discharged new patients without scheduled follow-up represent the highest-risk group, underscoring the need for systems-based interventions.<\/jats:p>","DOI":"10.3390\/jcm15135071","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:11Z","timestamp":1782780911000},"page":"5071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidental Malignancies in the Emergency Department: Missed Diagnoses, Radiological Difficulty, and a Risk-Based Framework for Follow-Up"],"prefix":"10.3390","volume":"15","author":[{"given":"Hiromi","family":"Takayasu","sequence":"first","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9558-2570","authenticated-orcid":false,"given":"Kazuyuki","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2285-6603","authenticated-orcid":false,"given":"Mako","family":"Kitazono","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Takeyama","sequence":"additional","affiliation":[{"name":"Department of Radiology, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Yamaga","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kaki","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4616-2171","authenticated-orcid":false,"given":"Atsuo","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"},{"name":"Department of Emergency & Critical Care Center, Kawakita General Hospital, 1-6-1 Asagaya-kita, Suginami-ku, Tokyo 166-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayako","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City 227-8501, Kanagawa, Japan"},{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6188-8568","authenticated-orcid":false,"given":"Jun","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"},{"name":"Department of Emergency and Disaster Medicine, Showa Medical University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo 135-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4451-0382","authenticated-orcid":false,"given":"Kenji","family":"Dohi","sequence":"additional","affiliation":[{"name":"Department of Emergency, Critical Care Medicine and Disaster Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.annemergmed.2022.03.027","article-title":"Incidental radiology findings on computed tomography studies in emergency department patients: A systematic review and meta-analysis","volume":"80","author":"Evans","year":"2022","journal-title":"Ann. Emerg. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"624847","DOI":"10.1155\/2011\/624847","article-title":"Incidental findings on CT scans in the emergency department","volume":"2011","author":"Thompson","year":"2011","journal-title":"Emerg. Med. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1007\/s00261-015-0349-4","article-title":"Incidental findings detected on emergency abdominal CT scans: A 1-year review","volume":"40","author":"Kelly","year":"2015","journal-title":"Abdom. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jacr.2023.01.001","article-title":"White paper: Best practices in the communication and management of actionable incidental findings in emergency department imaging","volume":"20","author":"Moore","year":"2023","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8710","DOI":"10.1002\/cam4.5600","article-title":"Diagnosis of cancer in the emergency department: A scoping review","volume":"12","author":"Fauvel","year":"2023","journal-title":"Cancer Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jemermed.2008.11.019","article-title":"The prevalence of incidental findings on abdominal computed tomography scans of trauma patients","volume":"38","author":"Ekeh","year":"2010","journal-title":"J. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.jemermed.2008.01.021","article-title":"Frequency and follow-up of incidental findings on trauma computed tomography scans: Experience at a level one trauma center","volume":"38","author":"Munk","year":"2010","journal-title":"J. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/01.ta.0000249129.63550.cc","article-title":"Incidental CT findings in trauma patients: Incidence and implications for care of the injured","volume":"62","author":"Paluska","year":"2007","journal-title":"J. Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1148\/rg.2015150023","article-title":"Understanding and confronting our mistakes: The epidemiology of error in radiology and strategies for error reduction","volume":"35","author":"Bruno","year":"2015","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1148\/rg.2018170107","article-title":"Bias in radiology: The how and why of misses and misinterpretations","volume":"38","author":"Busby","year":"2018","journal-title":"Radiographics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jacr.2016.10.009","article-title":"Tired in the reading room: The influence of fatigue in radiology","volume":"14","author":"Waite","year":"2017","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.annemergmed.2011.10.023","article-title":"Effective discharge communication in the emergency department","volume":"60","author":"Stack","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1017\/S1481803500012860","article-title":"Emergency department discharge instructions comprehension and compliance study","volume":"7","author":"Clarke","year":"2005","journal-title":"Can. J. Emerg. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1148\/radiol.2016152188","article-title":"\u201cChasing a ghost\u201d: Factors that influence primary care physicians to follow up on incidental imaging findings","volume":"281","author":"Zafar","year":"2016","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1056\/NEJMp1204431","article-title":"The growing role of emergency departments in hospital admissions","volume":"367","author":"Schuur","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.jacr.2020.11.006","article-title":"Management strategies to promote follow-up care for incidental findings: A scoping review","volume":"18","author":"Crable","year":"2021","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.jacr.2018.11.010","article-title":"Location, location, location: The association between imaging setting and follow-up of findings of indeterminate malignant potential","volume":"16","author":"Liao","year":"2019","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jacr.2019.11.023","article-title":"Process improvement for communication and follow-up of incidental lung nodules","volume":"17","author":"Kang","year":"2020","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.annemergmed.2022.04.026","article-title":"Catching those who fall through the cracks: Integrating a follow-up process for emergency department patients with incidental radiologic findings","volume":"80","author":"Barrett","year":"2022","journal-title":"Ann. Emerg. Med."},{"key":"ref_20","first-page":"302","article-title":"Electronic health record closed-loop communication program for unexpected nonemergent findings","volume":"301","author":"Schwaner","year":"2021","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"611","DOI":"10.2214\/AJR.12.10375","article-title":"Cognitive and system factors contributing to diagnostic errors in radiology","volume":"201","author":"Lee","year":"2013","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1148\/rg.2018180021","article-title":"Fundamentals of diagnostic error in imaging","volume":"38","author":"Itri","year":"2018","journal-title":"Radiographics"},{"key":"ref_23","first-page":"k2387","article-title":"Prevalence and outcomes of incidental imaging findings: Umbrella review","volume":"361","author":"Muntinga","year":"2018","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5071\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:40:11Z","timestamp":1782783611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":23,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135071"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135071","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}