The incidentaloma: a medicolegal dilemma.
In October 2006, an 83-year-old, small, fraillooking woman, with a history of chronic obstructive pulmonary disease and smoking a pack of cigarettes daily for the previous 50 years, visited her family internist with complaints of cough and shortness of breath. Her physician referred her to the outpatient radiology department of a local hospital, where on October 19, 2006 she underwent posterior-anterior and lateral chest radiographies. A radiologist interpreted the examination as disclosing “evidence of chronic obstructive pulmonary disease with scattered fibrotic changes, but otherwise essentially normal study.” Ten months later the patient, now complaining of increasing cough and chest discomfort, again underwent chest radiography on the order of her family physician. A different radiologist interpreted the examination as disclosing a “2 cm mass in the right mid-lung field, suspicious for malignancy.” Computed tomography (CT) confirmed the finding, and a subsequent biopsy disclosed non–small cell carcinoma. Despite chemotherapy, the patient developed numerous metastases and died on July 17, 2008. A short time after the diagnosis was established, the patient’s physician informed the patient and her husband that in reviewing the earlier radiographs taken in October, 2006 with a radiologist, it was discovered that a small nodule had been present in the right midlung field, but no mention of it had been made in the radiographic report. Soon thereafter, the patient and her family filed a medical