Incidental findings in 1000 consecutive CT angiograms for DIEP flap breast reconstruction.

Preoperative CT angiography of the abdomen and pelvis is the gold standard for patients undergoing Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction (Pratt et al., Ann Plast Surg 69:3–9, 2012), with incidental findings in these scans varying from 13 to 74% (Hughes et al., Eur J Surg Oncol (EJSO) 42:59–63, 2016; Ho et al., J Plast Reconstr Aesthetic Surg 69:e97–e102, 2016). This study aimed to clarify the rate and nature of the incidental findings in a large single center cohort of patients undergoing DIEP flap breast reconstruction. An analysis of 1000 CT angiograms from 2013 to 2019 identified a risk rate of 23.5% for incidentalomas with the most commonly reported being liver cysts (3.6%), sclerotic bone lesions (3,3%), uterine fibroids (3%), spinal degenerative changes (2.6%), and ovarian cysts (2.5%). All findings were benign in nature, 2 cases (0.2%) required further invasive imaging, and in 1 case (0.1%) of ovarian cyst the procedure had to be delayed until further gynaecological consultation. To our knowledge, this is the largest cohort in literature. CT incidental findings (incidentalomas) remain common but rarely complicate the patient journey, even if further investigations are needed. Informing patients of the high chance (23.5%) of an abnormal finding on CTA should be a part of the consultation, acknowledging that the vast majority of incidentalomas are benign. [ABSTRACT FROM AUTHOR]