A 50 year old male airline transport pilot licence (ATPL) pilot had been on a CASA audit requirement (CAR) for Non-Hodgkin’s Lymphoma since 2010. As part of his ongoing haematological medical surveillance a neck, chest, abdomen and pelvis CT scan in 2014 reported an “incidental” abnormality in his neck. Perusal of the first several articles raised from a “Google” search of the abnormality linked it with possible stroke, carotid dissection and death. Would CASA now cancel or suspend this pilot’s medical? Could this pilot become a casualty of VOMIT (victim of modern imaging technology1)? If DAMEs were delegated the responsibility to be able to issue Class 1 certificates, how many would spend the time (and charge commensurately) to perform a more detailed literature search and critical appraisal to support an aero-medical decision one way or the other? This paper discusses the process and time taken to aero-medically assess a pilot who had an incidental radiological diagnosis of a rare condition.