Incidental Findings on Abdominopelvic CT in Young Korean Soldiers: Prevalence, Clinical Relevance, and Healthcare System Implications

Background Abdominopelvic computed tomography (APCT) is a frontline diagnostic modality for acute abdominal pain, but it often reveals incidental findings (IFs) that are unrelated to the presenting complaint. While many IFs are benign, some require structured follow-up and long-term management. In military settings, where healthcare access may be limited and continuity of care is vulnerable to frequent personnel transfers, IFs represent a critical challenge for health system readiness. Methods We retrospectively reviewed the records of 1,062 male Korean soldiers (aged 18–28 years) who underwent APCT for acute abdominal pain at a military emergency department between January 2021 and December 2022. Two board-certified radiologists independently re-assessed all scans to identify IFs and classify those requiring clinical follow-up. Prevalence estimates were calculated, and clinically significant findings were highlighted in the context of healthcare delivery. Results Incidental findings were identified in 218 of 1,062 patients (20.5%). The most frequent were renal cysts (6.2%) and hepatobiliary abnormalities (7.5%). Clinically significant lesions included Bosniak II-F renal cysts (0.3%), inherited cystic kidney diseases (0.2%), intraductal papillary mucinous neoplasm (0.1%), adrenal incidentalomas (0.4%), and appendiceal mucoceles (0.2%). These conditions required specialist follow-up or surgical management. Exploratory analysis also revealed clusters of co-occurring IFs, such as renal and hepatic cysts, highlighting potential shared risk factors. Conclusions Incidental findings on APCT are prevalent even in a young, ostensibly healthy military population. Their discovery reveals a gap between detection and effective follow-up in military healthcare systems. To mitigate long-term health risks and maintain operational readiness, implementation of structured reporting protocols, automated tracking systems, and cross-institutional referral pathways is essential. These measures are particularly critical in environments where access to subspecialty care is constrained and service members frequently change duty stations.