Incidental chest findings on coronary CT angiography: a pictorial essay and management proposal.

Publisher: Sociedade Brasileira de Pneumologia e Tisilogia Country of Publication: Brazil NLM ID: 101222274 Publication Model: eCollection Cited Medium: Internet ISSN: 1806-3756 (Electronic) Linking ISSN: 18063713 NLM ISO Abbreviation: J Bras Pneumol Subsets: MEDLINE

Original Publication: Brasilia, DF, Brasil : Sociedade Brasileira de Pneumologia e Tisilogia, [2004]-

Computed Tomography Angiography* ; Coronary Artery Disease*/diagnostic imaging; Coronary Angiography ; Humans ; Incidental Findings ; Tomography, X-Ray Computed

Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.

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Date Created: 20220518 Date Completed: 20220520 Latest Revision: 20220716

20240829

PMC9064655

10.36416/1806-3756/e20220015

35584528