Abstract Introduction Incidental findings on imaging can uncover clinically significant anomalies, which may lead to acute emergencies. Surveillance imaging for one condition may, in turn, lead to further incidental diagnoses. This case highlights the importance of careful review of imaging and close follow-up, as more than one disease process may be present. Case Presentation A16-year-old male presented with abdominal pain to an outside emergency department. Due to concern for appendicitis, a contrast CT scan of the abdomen and pelvis was performed. His appendix was normal; however, the lower lung slices revealed an aberrant arterial systemic supply to the right lower lobe arising from the descending thoracic aorta. The patient was then referred to pulmonology and subsequently to interventional radiology. He was asymptomatic at these visits and family opted against elective coiling at that time. He then participated in competitive shotput and javelin nationally. Soon after this competition, he had frank hemoptysis and was brought back to the emergency department. A stat chest CT scan showed active bleeding where the known aberrant artery was. Embolization was performed soon after and the patient improved. Follow up CT scan of the chest showed no further bleeding and preserved lung parenchyma, with no evidence of infarction. Lobectomy was deemed unnecessary at this time. However, these successive chest CT scans also showed evidence of thoracic outlet syndrome (TOS) on his throwing side. He showed no symptoms of vascular or neurogenic compromise. He was referred to physical therapy for further prevention of complications from TOS. Discussion This case demonstrates how incidental findings can turn into acute emergencies. It also illustrates the importance of thorough follow-up and review of imaging even when there is a known diagnosis, as there may be additional and unrelated pathology present. Multidisciplinary collaboration and individualized follow-up are needed to optimize outcomes.Imaging: Left: RLL showing bleeding surrounding aberrant arterial supply causing hemoptysis. Right: RUE shows significant narrowing of the proximal right subclavian vein between the clavicle and first rib with multiple collateral vessels in the right axilla and right neck contributing to enhancement of the right internal jugular vein from the collateral flow, consistent with thoracic outlet syndrome. This abstract is funded by: None
Christian et al. (Fri,) studied this question.