Extracardiac Findings on Cardiac Computed Tomography: A Radiologist’s Perspective

J Am Coll Cardiol. 2010; 55(15):1566-8

Johnson KM

There has been debate in the cardiology literature as to how to handle unexpected noncardiac findings on cardiac computed tomography examinations. From the perspective of a radiologist, all structures on the presented images should be assessed. The interpreter needs to carefully window the findings down to potentially important ones. Then the question becomes what to do next. Cardiologists who take primary responsibility for cardiac computed tomography examinations must be able to recognize noncardiac findings that require immediate action. Although infrequent, their clinical impact can be substantial. False-positive results will occur; minimizing these depends on knowledge of common trivial findings, normal variants, and customary workup and follow-up recommendations. This implies experience in interpreting structures outside the heart. Therefore, help from an experienced and decisive radiologist should maximize sensitivity for significant lesions while minimizing the number of false-positive diagnoses.

PMID: 20378072

4 Responses

  1. Ronen Rubinshtein, MD  on April 18th, 2010

    This is in my opinion a thoughtful, balanced, and interesting viewpoint! This short paper describe a useful approach to reading extracardiac finding in cardiac CT, and despite the fact that it is not dealing with any para-professional “issues”, it still reminds us that “patient come first.”

  2. Jacobo Kirsch, MD  on April 18th, 2010

    A topic that remains current; as the number of scans continues to increase, recognizing the important extra-cardiac findings remains of paramount importance.
    Like this paper mentions: “The trick is not to create new problems with your readings”. Few years ago, we published a small retrospective study where we attempted to classify the incidental findings by their significance and found that in 100 consecutive patients undergoing coronary CTA, there were 16 significant extra-cardiac findings in 11 patients. [link]

  3. Paul Schoenhagen, MD  on April 23rd, 2010

    Also see:

    Lung Cancer Detected at Cardiac CT: Prevalence, Clinico radiologic Features, and Importance of Full-Field-of-View Images.
    Tae Jung Kim, Dae Hee Han, Kwang Nam Jin, and Kyung Won Lee.
    Radiology 2010;255 369-376.

  4. Paul Schoenhagen, MD  on April 23rd, 2010

    A second look? New study supports full-field cardiac CT to find incidental lung cancers.
    HeartWire.
    Reed Miller. April 23, 2010.


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