J Korean Soc Radiol.  2016 Nov;75(5):376-383. 10.3348/jksr.2016.75.5.376.

Characteristics of Chest Lesions Missed on Neck CT Interpretations

• Park S
• Beck KS
• Jang J
• Jung JI
• Ahn MI

• KMID: 2355991
• DOI: http://doi.org/10.3348/jksr.2016.75.5.376

Abstract

PURPOSE
The purpose of this study was to identify the characteristics of chest lesions that are missed in interpretations of neck computed tomography (CT) scans.
MATERIALS AND METHODS
A total of 240 consecutive neck CT scans were retrospectively analyzed to determine whether chest lesions were included or not. All missed chest lesions, which had not been described on neck CT reports, were recorded, and classified according to their clinical significance (insignificant, indeterminate, or significant) and awareness (known or unknown) at the time of CT interpretation, and their radiologic patterns were analyzed.
RESULTS
Eighty seven (36.3%) of 240 neck CT scans had 105 chest lesions, and 88 of these were not described on the neck CT reports. Thirty seven clinically known or insignificant lesions were excluded, resulting in a miss rate for chest lesions of 35.2% (37/105), with six of these (5.7%) being potentially significant. The most common location of missed chest lesions was the lung (56/88, 63.6%), and 45 (80.4%) of these missed lung lesions were visualized only with lung window settings.
CONCLUSION
Chest lesions were common and frequently missed on neck CT interpretations. When reviewing neck CT scans, a special attention should be given to lung lesions by using lung window settings.

MeSH Terms

Diagnostic Errors
Lung
Neck*
Retrospective Studies
Thorax*
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Neck CT image at the level of lung apex in a 42-year-old man presenting with tongue discomfort. Multiple clustered, centrilobular nodules are noted in the left upper lobe, raising the possibility of pulmonary tuberculosis, which were missed on neck CT interpretation.

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  Fig. 2 Neck CT at the level of lung apex in a 53-year-old man with peritonsilar abscess. CT image with lung window setting shows multiple variable sized bullae in the right lung apex, which was not described in neck CT report. Minimal centrilobular emphysema is also noted in the left upper lobe.

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  Fig. 3 Missed and significant chest lesion on neck CT in an 80-year-old man with thyroid cancer. The lower part of neck CT image with lung window setting (A) shows an irregular shaped peribronchial ground-glass opacity nodule (arrows) in the right upper lobe, suggesting adenocarcinoma of the lung. On mediastinal window setting (B), this lesion is not seen.

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