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Duplication of the inferior vena cava is a rare malformation, normally without clinical impact, explained by abnormal development and regression of certain segments of the venous system during embryonic life. However, its presence and type should be systematically reported in the radiological report because of its potential implications for diagnostic and interventional procedures. This observation describes the case of a 77-year-old man with a complete asymmetric duplication of the inferior vena cava (type III IVC according to Natsis) that was incidentally discovered on CT-scan.

Device insertion is a common cardiovascular procedure. Devices are implanted into the right heart, acting as a safeguard against systemic thromboembolism. Lead insertion into the left ventricle is rare, but carries dangerous consequences of thromboembolic events. Diagnosis and intervention of an inadvertently placed lead is essential. This is a case of a defibrillator lead inadvertently inserted into the left cavity, discovered 6 years after implantation., Pacemakers are typically used to restore normal heart rhythm to the heart. While typically found screwed in the right ventricle, pacemaker leads may sometimes travel through the walls of the heart and become lodged in the right ventricle. This complication must be resolved immediately due to the high risk of thromboembolism.

CRISPR research began over 30 years ago with the incidental discovery of an unusual nucleotide arrangement in the Escherichia coli genome. It took 20 years to find the main function of CRISPR-Cas systems as an adaptive defence mechanism against invading nucleic acids, and our knowledge of their biology has steadily increased ever since. In parallel, the number of applications derived from CRISPR-Cas systems has risen spectacularly. The CRISPR-based genome editing tool is arguably the most exciting application in both basic and applied research. Lately, CRISPR-Cas research has partially shifted to the least understood aspect of its biology: the ability of CRISPR-Cas systems to acquire new immunities during the so-called adaptation step. To date, the most efficient natural system to readily acquire new spacers is the type II-A system of the gram-positive dairy bacterium Streptococcus thermophilus. The discovery of additional systems able to acquire new spacers will hopefully draw more attention to this step of CRISPR-Cas biology. This review focuses on the breakthroughs that have helped to unravel the adaptation phase and on questions that remain to be answered.

International audience; Background: Incidentally discovered suspected diffuse low-grade gliomas (LGGs) on brain imaging pose a challenge to neurosurgeons. Modern surgical series of LGGs favor early prophylactic surgery with a maximal extent of resection. However, some nonevolutive lesions may mimic LGGs on magnetic resonance imaging (MRI).Objective: To determine objective criteria to advocate surgical resection of an incidentally discovered suspected LGG based upon MRI findings.Methods: The prospective cohort of patients referred to our institution for an incidental finding suggestive of LGG was retrospectively reviewed. Stable lesions underwent systematic serial MRI follow-up, while evolutive lesions underwent prophylactic surgery under awake conditions. Initial clinico-radiological features were compared between stable and evolutive lesions in order to determine predictive criteria of further evolution.Results: Among 101 patients referred for surgical resection of incidentally discovered suspected LGG in our center, 19 patients (18.8%) had nonevolutive MRI lesions after a mean follow-up of 46.9 ± 34.9 mo. Insular topography (P = .003), higher mean volume at discovery (19.2 vs 5.2 cm3, P < .001), and adjacent sulcal effacement (P = .001) were associated with evolutive lesions. Histopathological diagnosis of LGG was confirmed in all surgical cases.Conclusion: Increasing volume is an effective predictor of LGG diagnosis in incidental MRI findings, as all patients who subsequently underwent surgery had confirmed histopathological diagnosis of diffuse glioma. Approximately 18.8% of incidental findings were stable over time. Insular topography, adjacent sulcal effacement, and volume greater than 4.5 cm3 were predictive of further radiological progression. These significant elements will help neurosurgeons to define personalized strategies in this complex setting of incidental discovery.

A healthy, asymptomatic woman was referred after incidental discovery of a right superior incongruous hemianopia. Magnetic resonance imaging disclosed a schizencephalic cleft passing through Meyer’s loop of the left optic radiation. The lesion may have resulted from a focal vascular accident or disruption of cortical neurogenesis during gestation.

Le termeincidentalome, créé en 1982, s’est, depuis, diffusé dans la littérature médicale. Il ne semble cependant pas exister de définition précise pour décrire ce qu’est un incidentalome. Dans les usages initiaux, l’incidentalome désignait une masse détectée à l’occasion d’un examen d’imagerie prescrit à visée diagnostique sans qu’un lien ne soit déterminé avec le motif de réalisation de l’examen. La qualification d’« incidentalome » de cette masse n’apportait aucune précision sur sa nature, celle-ci pouvant être située dans de nombreuses zones anatomiques, être sécrétante ou non, être bénigne ou maligne… Aujourd’hui, le terme d’incidentalomeporte une dimension beaucoup plus large, semblant recouvrir la notion de découverte fortuite, qu’elle soit radiologique, biologique ou génétique. Cet usage évolutif du terme démontre son caractère heuristique. Il est le signe d’une modification de la médecine moderne qui hésite entre une clinique des patients et une clinique des données. Les découvertes fortuites sont un phénomène connu et anticipé par les radiologues. Ces découvertes ne sont donc plus fortuites, ni même inattendues, mais bien secondaires à l’usage de la technologie en santé.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a serious congenital malformation. Reports about asymptomatic, incidentally discovered ALCAPA in adults are scarce. We describe a patient with no known pre-existing cardiac condition admitted to our hospital with coronavirus disease 2019 (COVID-19) and was incidentally found to have ALCAPA. To the best of our knowledge, this is the first reported case of incidentally discovered ALCAPA in a COVID-19 patient and highlights the importance of appropriate investigation of the coronary status by Multidetector Cardiac Computed Tomographic Angiography (MDCCTA) in individuals with asymptomatic left ventricular dysfunction. The presentation of this case, discussion and literature review serves to iterate the necessity of appropriately investigating patients with asymptomatic LV dysfunction.

Serous cystadenofibroma of the ovary is a cystic neoplasm containing fibrous component, and lining of high, cylindrical, and ciliated epithelial cells surrounded by clear serous fluid, with smooth or papillary surface and abundant vessels. Serous cystadenofibroma in the present case report was an incidental discovery observed during an abdominal and pelvic cavity review performed in a 39-week elective cesarean section applied to in a 32-year-old patient who presented uneventful pregnancy. The importance of conducting inventories of these cavities during cesarean sections to identify asymptomatic adnexal masses unseen in prenatal ultrasonography is clear.

Late thrombus formation is a rare complication associated with patent foramen ovale (PFO) closure devices. We report the case of an incidental discovery of large thrombi in both atria 9 months after percutaneous PFO occlusion that required cardiac surgery for thrombi removal. (Level of Difficulty: Beginner.), Graphical abstract, Late thrombus formation is a rare complication associated with patent foramen ovale (PFO) closure devices. We report the case of an incidental…

Severe mitral valve regurgitation can be caused by a spectrum of disorders that can influence the management of this entity. Here we describe the diagnostic work-up in the case of a patient presenting with flail mitral valve secondary to Barlow’s disease and concomitant fever, underscoring the difficulty in providing differential diagnosis of the underlying causative etiology and to plan subsequent appropriate treatment. Diagnostic tests leaded to the incidental discovery of concomitant iliac artery aneurysm; hence, we discuss the association between Barlow’s disease and arterial abnormalities, possibly pointing towards a syndromic pattern related to common pathogenic background affecting connective tissue.

Although noninvasive prenatal testing is not intended to identify maternal genomic information, it can provide other information that may lead to the incidental discovery of coexisting conditions including maternal malignancy.

Rhabdomyosarcoma is an uncommon soft tissue sarcoma that rarely presents in adults. Clinical presentation is dependent on site and size. We present the case of a woman who presented with acute-onset dyspnoea and whose pathology report confirmed embryonal rhabdomyosarcoma (ERMS) seen as an incidental finding on chest computed tomography. We also describe the clinical, laboratory and radiological work-up conducted to diagnose and manage ERMS in the critical care setting. LEARNING POINTS Rhabdomyosarcoma is a rare malignancy with a poor prognosis in adults compared with children, especially if it presents in an unfavourable primary site and has an unfavourable histological diagnosis. Immunohistochemical diagnosis remains the gold standard for embryonal rhabdomyosarcoma diagnosis and differentiation from similar malignancies on initial imaging studies. Management of adult rhabdomyosarcoma is usually multimodal with surgical resection and a combination of chemo and radiotherapy.

A left ventricular aneurysm is a rare post myocardial infarction complication. Ventricular aneurysms form as post-ischemic cardiac remodeling creates a weaker, fibrotic area that may bulge outwards against interventricular pressures over time. Patients with ventricular aneurysms have increased mortality and are at higher risk of various cardiac complications, such as cardiac arrest, arrhythmias, thrombus formation, reduced cardiac output, or aneurysmal rupture. Prompt diagnosis and treatment are critically important in these patients. We highlight the hospital course of a patient with an extensive cardiac history presenting for syncope with the discovery of a left ventricular aneurysm. The radiographic features of the left ventricular aneurysm are described, as well as formation, risk factors, and complications.

Three types of cardiac outpouchings are encountered on cardiovascular imaging: diverticula, aneurysms and pseudoaneurysms. The underlying physiology, imaging findings, risk of rupture, and optimal treatment varies for each and a correct diagnosis is critical. We report a case of a rare, incidentally discovered right ventricular aneurysm that was characterized by transthoracic echocardiogram, computed tomography, and cardiac MRI. The types of cardiac outpouchings are reviewed, and we discuss the selection of imaging modality, keys to distinguishing the outpouchings, and management strategies.

Tracheal diverticulum is observed in 1%-4% of the population, however, multiple tracheal diverticula are a rare occurrence. In this paper, we present a 75-year-old male, who was referred to a computed tomography-scan of the neck, chest, abdomen, and pelvis because of an unintended weight loss, fatigue, and a smoking history of 60 pack-years. A definitive cause for the symptoms was not found, however as an incidental finding, the patient was diagnosed with multiple tracheal diverticula along the back wall of trachea and left main bronchus. Despite the rare occurrence, it is important to recognize multiple tracheal diverticula in the diagnostic process, because of the possibility of either removing the diverticula or initiating prophylactic actions to prevent complications such as empyema and pneumomediastinum.

An incidental discovery of Wolff Parkinson White (WPW) pattern on the electrocardiogram (ECG) is not an infrequent finding facing the physician. Most patients discovered incidentally are asymptomatic and it is hard to justify further management of such patients given the time-honored adage to “first do no harm.” However, this finding does have implications. This article is an attempt to guide clinicians about this important issue that is often faced in the office. Keywords: WPW, Ventricular preexcitation, SCD, Supraventricular tachycardia, Risk stratification, Ablation

Introduction: Surgical clips (SCs) have been widely used for a variety of surgical procedures over the years. Despite their advantages and proven effectiveness, several clip-related complications have been reported, creating dilemmas as to their optimal use. Case description: Herein, we present a rare delayed and incidental discovery of two endourethral metallic SCs in a 77-year-old male seeking treatment for acute renal colic. The patient had undergone open radical retropubic prostatectomy 10 years ago, and had an uneventful postoperative recovery. Computed tomography scan revealed left-sided hydronephrosis secondary to proximal ureteral calculus, as well as SCs at the level of vesico-urethral (VUR) anastomosis. Flexible cystoscopy confirmed the imaging findings, showing two endourethral clips, partly obstructing the VUR. Firstly, a serial wire-guided dilation took place, followed by left ureteral double-J stent placement. Unfortunately, the clips could not be concurrently removed due to their firm attachment to the bladder neck. Hence, our patient was scheduled for transurethral resection of the bladder neck and simultaneous endoscopic clip removal. Conclusions: To the best of our knowledge, this is the first report to highlight such a delayed incidental finding, 10 years after open retropubic radical prostatectomy (RRP), during a JJ stent insertion for obstructive uropathy without previous clip-induced lower urinary tract symptoms. Although rare, physicians should be aware of the potential clip-related complications arising either in the short- or long-term postprostatectomy setting.

Device insertion is a common cardiovascular procedure. Devices are implanted into the right heart; which is a safeguard against systemic thromboembolism. Lead insertion into the left ventricle is rare. This is a case of a defibrillator lead inadvertently inserted into the left cavity. This was discovered 6 years later.

Background-The current study aims to highlight the importance of autopsies in not just finding the causeof death; but also, incidental discovery of various rare lesions, that may or may not be the cause of death.The study also aims to highlight the common cause of death, spectrum of common incidental findings andreporting of various rare, interesting cases. Method- This is a retrospective study conducted between year2013 to 2020 on 800 autopsies and their histopathological examination in Pathology Department, GMC,Patiala. Conclusion- Finding of this study concludes the importance of histopathological autopsy in not justhighlighting the cause of death but also finding many rare diseases, thus enriching the field of medicine andpathology by observing the histological findings and also sometimes the course of rare diseases.

Odontogenic myxoma is a benign tumor of the maxillae of mesenchymal origin. It is a rare lesion. The discovery of this lesion is most often fortuitous. Its clinical, radiological and histological diagnosis poses various problems which are addressed after the presentation of a lytic lesion of the right hemi-mandible, of multilocular appearance, having caused slight facial deformation in a 40 years old woman. Treatment is surgical.

Amyand's hernia (AH) is a rare form of an inguinal hernia where the vermiform appendix is found within the hernia sac. Diagnosis is usually based on incidental finding intraoperatively. The AH makes up a small proportion of all inguinal hernia cases, and concurrent acute ischemic complication makes up an even smaller subset. We present an 85-year-old male who was referred to general surgery services for a growing mass on his right lower quadrant in the inguinal region. This was non-tender on palpation, and therefore there was no suspicion of ischaemic complications. An open hernioplasty was performed with resection of the appendix. The AH in this patient would be conventionally classified as type 1 AH, which would be managed with hernial reduction and mesh repair. The anatomical variance in our patient's AH increased the risk for hernial incarceration; hence an appendectomy was also performed despite the absence of acute appendicitis. This approach was also deemed necessary to avoid the recurrence of hernia due to its large size and adhesions within the hernial sac. This study reports a novel management approach for an incidentally discovered type 1 AH. It highlights that there is a lack of management guidance for the AH anatomical variants. The classification and management for AH under the conventional Losanoff and Basson's AH classification model have limitations that can be amended by incorporating the physical dimensions of the AH. This approach will enable surgeons to recognize and manage more variations of AH while mitigating downstream complications.

Gastric diverticula rarely occur in adolescence. In adults, they are predominantly congenital, asymptomatic, and are located adjacent to the gastroesophageal junction on the posterior aspect of the stomach wall. In this report we present a 14-year-old female who underwent laparoscopic gastric diverticulectomy after incidental discovery on magnetic resonance urography.

Emphysematous cystitis is an unusual urological emergency in clinical practice. The disease characteristics are still underreported. It is characterized by the presence of gas in the urinary bladder wall secondary to gas forming organism. We report an incidental finding of emphysematous cystitis in a 35-year-old secondary to a huge liver abscess in a poorly controlled blood sugar. The infection spread hematogenously to the urinary bladder wall that was managed conservatively by urethral catheter drainage and hepatic abscess drainage in adjunct with antimicrobial therapy. The patient had no urinary symptoms. The bladder wall gas disappeared during follow-up in 2 weeks.

We report the results of 18F-FDG PET/CT in an asymptomatic case of COVID-19 infection. A 27-year-old woman underwent FDG PET/CT for revaluation of a stage IIIE B Hodgkin lymphoma after the fourth cycle of chemotherapy. It showed intense avid FDG subpleural mixed ground-glass and consolidative lesions, especially in the left lung. Because of this morpho-metabolic aspect and the epidemic context, a viral pneumopathy was suspected. The patient who was initially asymptomatic was admitted for fever 28 hours after the PET/CT. The nasopharyngeal swab was positive for COVID-19, and the outcome was favorable.

Mucinous adenocarcinoma is a rare tumor that may be associated with longstanding perianal fistulas. It represents 6.9% of all anal cancers. The diagnosis of this malignancy can be delayed because the symptoms experienced by people with the disease are usually attributed to the fistula and not to malignant transformation. As a result, the diagnosis of perianal mucinous adenocarcinoma in the setting of chronic perianal fistulas requires a high index of clinical suspicion and specific histological features.

Microscopic hematuria is common incidental discovery on urinalysis. This teaching scripts leads the reader through a systematic approach to this problem. We emphasize the importance of discerning patient symptoms that might point towards an etiology, and the distinction between “glomerular” and “nonglomerular” etiologies.

Tarsal coalitions may cause altered foot biomechanics leading to patient disability from osteoarthritis and other sequelae. While some types of coalition are common, isolated talonavicular coalitions are relatively rare. We present two cases of osseous talonavicular coalition that were incidentally discovered in adults and were most likely asymptomatic. Talonavicular coalition may have a hereditary component and may be associated with other anomalies, but many seem isolated, asymptomatic, and incidental. Keywords: Talonavicular coalition, Talonavicular fusion, Tarsal coalition

Testicular tumours are increasing in incidence, especially in developed countries. This incidence increases specifically in the subpopulation of infertile men. This case highlights a young man incidentally diagnosed with a subcentimetric testicular lesion, who was discovered to have concomitant azoospermia. The authors review management strategies in this challenging case, as treatment options for men with infertility and concomitant testicular tumours vary from men who are fertile. Level of evidence: Not applicable for this multicentre audit.

Introduction and importance Amyand's hernia is a rare type of inguinal hernia with an incidence of about 0.1% of all inguinal hernias with most in occurring in childhood. It is characterized by the presence of the vermiform appendix within the hernia sac. Case presentation We report the case of 40-year-old female who underwent inguino-labial hernia repair with an incidental finding of a normal appendix within the sac; this was not predicted by the pre-operative ultrasound scan. Clinical discussion We recommend that a detailed ultrasound scan be done for all patients with an inguinal hernia to help to manage the patient timeously and safely. Conclusion We present a rare condition in a 40-year-old female with a right inguinal hernia, an Amyand's hernia., Highlights • We report a case of Amyand's hernia in a 40-year-old female who underwent inguinal hernia repair. • A normal appendix was found in the sac and reduced without appendicectomy. Hernia repair without mesh was then performed. • Ultrasound scan is an excellent technique to evaluate the inguinal region but remains operator dependent.

Key Clinical Message Cholecystocolic fistula, a rare complication of long‐standing gallstone disease, is a diagnostic challenge owing to nonspecific clinical presentation and lack of accurate preprocedural diagnostic modalities. In case of incidental discovery of the fistula during the surgical procedure, excision of the fistula with repair of the colonic defect is imperative.