Abstract
Background: This retrospective case series examines incidental findings (IFs) detected on abdominopelvic CT (APCT) among young Korean soldiers presenting with acute abdominal pain. APCT is a frontline test for acute abdominal pain but frequently reveals incidental findings (IFs) unrelated to the presenting complaint. While many IFs are benign, some require structured follow-up. In military settings with constrained access and frequent personnel transfers, IFs pose challenges for health-system readiness. Methods: We retrospectively reviewed 1062 male Korean soldiers (18-28 years) who underwent APCT for acute abdominal pain at a military emergency department (ED) between January 2021 and December 2022. Two board-certified radiologists independently reassessed all scans to identify IFs and to classify those requiring follow-up based on contemporary guidelines. Results: IFs were identified in 218/1062 (20.5%) patients. Common categories included renal cysts (6.2%) and hepatobiliary IFs (7.5%). Clinically significant lesions comprised Bosniak IIF renal cysts (0.3%), inherited cystic kidney disease (0.2%), IPMN (0.1%), adrenal incidentalomas (0.4%), and appendiceal mucoceles (0.2%). An exploratory analysis suggested co-occurrence clusters (e.g., renal and hepatic cysts). Conclusions: IFs on APCT are prevalent even in a young, ostensibly healthy military cohort, highlighting a gap between detection and effective follow-up. Implementing structured reporting, automated tracking, and cross-institution referral pathways may mitigate long-term risk and support operational readiness in settings with limited subspecialty access and frequent relocations.