Abstract
Although not the primary focus of the exams, cardiovascular structures are included to some extent on all abdominal or whole-body cross-sectional studies. Cardiovascular findings often present incidentally and may range from chronic to acute and emergent pathologies. Among the most common cardiovascular findings are the presence of cardiac calcifications, most commonly coronary, which correlate with the presence of coronary artery and valvular disease. Signs of myocardial ischemia, both acute and chronic, and its complications may also be visualized. Cardiac filling defects most commonly represent thrombus and are associated with systemic arterial embolic complications. Pericardial findings often manifest as effusion or thickening, which may lead to hemodynamic consequences visible at imaging. Incidental pulmonary emboli and systemic venous thrombi may be incidentally detected, particularly in hospitalized and oncologic patients, and warrant immediate attention. This review will highlight the appearance of common and important incidental cardiovascular findings and related pitfalls and discuss reporting and follow-up recommendations relevant to the abdominal radiologist.
Similar content being viewed by others
References
Choy G, Kropil P, Scherer A, et al. (2013) Pertinent reportable incidental cardiac findings on chest CT without electrocardiography gating: review of 268 consecutive cases. Acta Radiol 54(4):396–400. https://doi.org/10.1177/0284185113475918
Sverzellati N, Arcadi T, Salvolini L, et al. (2016) Under-reporting of cardiovascular findings on chest CT. Radiol Med 121(3):190–199. https://doi.org/10.1007/s11547-015-0595-0
Verdini D, Lee AM, Prabhakar AM, et al. (2018) Detection of Cardiac Incidental Findings on Routine Chest CT: The Impact of Dedicated Training in Cardiac Imaging. J Am Coll Radiol 15(8):1153–1157. https://doi.org/10.1016/j.jacr.2016.02.011
Abbara S, Blanke P, Maroules CD, et al. (2016) SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 10(6):435–449. https://doi.org/10.1016/j.jcct.2016.10.002
Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA (2009) Multidetector CT of thoracic aortic aneurysms. Radiographics 29(2):537–552. https://doi.org/10.1148/rg.292075080
Uretsky S, Chokshi N, Kobrinski T, et al. (2015) The interplay of physician awareness and reporting of incidentally found coronary artery calcium on the clinical management of patients who underwent noncontrast chest computed tomography. Am J Cardiol 115(11):1513–1517. https://doi.org/10.1016/j.amjcard.2015.02.051
Scholte AJ, Schuijf JD, Kharagjitsingh AV, et al. (2008) Prevalence of coronary artery disease and plaque morphology assessed by multi-slice computed tomography coronary angiography and calcium scoring in asymptomatic patients with type 2 diabetes. Heart 94(3):290–295. https://doi.org/10.1136/hrt.2007.121921
Budoff MJ, Shaw LJ, Liu ST, et al. (2007) Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 49(18):1860–1870. https://doi.org/10.1016/j.jacc.2006.10.079
Detrano R, Guerci AD, Carr JJ, et al. (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358(13):1336–1345. https://doi.org/10.1056/nejmoa072100
Xie X, Zhao Y, de Bock GH, et al. (2013) Validation and prognosis of coronary artery calcium scoring in nontriggered thoracic computed tomography: systematic review and meta-analysis. Circ Cardiovasc Imaging 6(4):514–521. https://doi.org/10.1161/circimaging.113.000092
Hecht HS, Cronin P, Blaha MJ, et al. (2017) 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr 11(1):74–84. https://doi.org/10.1016/j.jcct.2016.11.003
Munden RF, Carter BW, Chiles C, et al. (2018) Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 15(8):1087–1096. https://doi.org/10.1016/j.jacr.2018.04.029
Chiles C, Duan F, Gladish GW, et al. (2015) Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods. Radiology 276(1):82–90. https://doi.org/10.1148/radiol.15142062
Azour L, Kadoch MA, Ward TJ, Eber CD, Jacobi AH (2017) Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges. J Cardiovasc Comput Tomogr 11(1):8–15. https://doi.org/10.1016/j.jcct.2016.10.001
Koos R, Kuhl HP, Muhlenbruch G, et al. (2006) Prevalence and clinical importance of aortic valve calcification detected incidentally on CT scans: comparison with echocardiography. Radiology 241(1):76–82. https://doi.org/10.1148/radiol.2411051163
Liu F, Coursey CA, Grahame-Clarke C, et al. (2006) Aortic valve calcification as an incidental finding at CT of the elderly: severity and location as predictors of aortic stenosis. Am J Roentgenol 186(2):342–349. https://doi.org/10.2214/ajr.04.1366
Osterberger LE, Goldstein S, Khaja F, Lakier JB (1981) Functional mitral stenosis in patients with massive mitral annular calcification. Circulation 64(3):472–476
Holtz JE, Upadhyaya DS, Cohen BE, et al. (2012) Mitral annular calcium, inducible myocardial ischemia, and cardiovascular events in outpatients with coronary heart disease (from the Heart and Soul Study). Am J Cardiol 109(8):1092–1096. https://doi.org/10.1016/j.amjcard.2011.11.043
Schott CR, Kotler MN, Parry WR, Segal BL (1977) Mitral annular calcification. Clinical and echocardiographic correlations. Arch Intern Med 137(9):1143–1150
Mahnken AH, Muhlenbruch G, Das M, et al. (2007) MDCT detection of mitral valve calcification: prevalence and clinical relevance compared with echocardiography. Am J Roentgenol 188(5):1264–1269. https://doi.org/10.2214/ajr.06.1002
Toufan M, Javadrashid R, Paak N, Gojazadeh M, Khalili M (2012) Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography. Int J Gen Med 5:839–843. https://doi.org/10.2147/ijgm.s33665
Gollub MJ, Panu N, Delaney H, et al. (2012) Shall we report cardiomegaly at routine computed tomography of the chest? J Comput Assist Tomogr 36(1):67–71. https://doi.org/10.1097/rct.0b013e318241e585
Tomita H, Yamashiro T, Matsuoka S, et al. (2015) Changes in Cross-Sectional Area and Transverse Diameter of the Heart on Inspiratory and Expiratory Chest CT: Correlation with Changes in Lung Size and Influence on Cardiothoracic Ratio Measurement. PLoS ONE 10(7):e0131902. https://doi.org/10.1371/journal.pone.0131902
Eifer DA, Nguyen ET, Thavendiranathan P, Hanneman K (2018) Diagnostic Accuracy of Sex-Specific Chest CT Measurements Compared With Cardiac MRI Findings in the Assessment of Cardiac Chamber Enlargement. Am J Roentgenol 211(5):993–999. https://doi.org/10.2214/ajr.18.19805
Benedetti N, Hope MD (2015) Prevalence and significance of incidentally noted dilation of the ascending aorta on routine chest computed tomography in older patients. J Comput Assist Tomogr 39(1):109–111. https://doi.org/10.1097/rct.0000000000000167
Rogers IS, Massaro JM, Truong QA, et al. (2013) Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol 111(10):1510–1516. https://doi.org/10.1016/j.amjcard.2013.01.306
Hiratzka LF, Bakris GL, Beckman JA, et al. (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121(13):e266–e369. https://doi.org/10.1161/cir.0b013e3181d4739e
Roos JE, Willmann JK, Weishaupt D, et al. (2002) Thoracic aorta: motion artifact reduction with retrospective and prospective electrocardiography-assisted multi-detector row CT. Radiology 222(1):271–277. https://doi.org/10.1148/radiol.2221010481
Johnson KM, Johnson HE, Dowe DA (2009) Left ventricular apical thinning as normal anatomy. J Comput Assist Tomogr 33(3):334–337. https://doi.org/10.1097/rct.0b013e3181870356
Weinsaft JW, Kim HW, Shah DJ, et al. (2008) Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction. J Am Coll Cardiol 52(2):148–157. https://doi.org/10.1016/j.jacc.2008.03.041
Shah DJ, Kim HW, James O, et al. (2013) Prevalence of regional myocardial thinning and relationship with myocardial scarring in patients with coronary artery disease. JAMA 309(9):909–918. https://doi.org/10.1001/jama.2013.1381
McCarthy CP, Vaduganathan M, McCarthy KJ, et al. (2018) Left Ventricular Thrombus After Acute Myocardial Infarction: Screening, Prevention, and Treatment. JAMA Cardiol 3(7):642–649. https://doi.org/10.1001/jamacardio.2018.1086
Kim DH, Choi SI, Choi JA, et al. (2006) Various findings of cardiac thrombi on MDCT and MRI. J Comput Assist Tomogr 30(4):572–577
Bussani R, De-Giorgio F, Abbate A, Silvestri F (2007) Cardiac metastases. J Clin Pathol 60(1):27–34. https://doi.org/10.1136/jcp.2005.035105
Truong MT, Erasmus JJ, Gladish GW, et al. (2003) Anatomy of pericardial recesses on multidetector CT: implications for oncologic imaging. Am J Roentgenol 181(4):1109–1113. https://doi.org/10.2214/ajr.181.4.1811109
Peebles CR, Shambrook JS, Harden SP (2011) Pericardial disease—anatomy and function. Br J Radiol 84(Spec No 3):S324–337. https://doi.org/10.1259/bjr/16168253
Mahammedi A, Oshmyansky A, Hassoun PM, Thiemann DR, Siegelman SS (2013) Pulmonary artery measurements in pulmonary hypertension: the role of computed tomography. J Thorac Imaging 28(2):96–103. https://doi.org/10.1097/rti.0b013e318271c2eb
Simonneau G, Gatzoulis MA, Adatia I, et al. (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 62(25 Suppl):D34–D41. https://doi.org/10.1016/j.jacc.2013.10.029
McLaughlin VV, Archer SL, Badesch DB, et al. (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol 53(17):1573–1619. https://doi.org/10.1016/j.jacc.2009.01.004
Storto ML, Di Credico A, Guido F, Larici AR, Bonomo L (2005) Incidental detection of pulmonary emboli on routine MDCT of the chest. Am J Roentgenol 184(1):264–267. https://doi.org/10.2214/ajr.184.1.01840264
Browne AM, Cronin CG, English C, et al. (2010) Unsuspected pulmonary emboli in oncology patients undergoing routine computed tomography imaging. J Thorac Oncol 5(6):798–803. https://doi.org/10.1097/jto.0b013e3181d6153a
Ritchie G, McGurk S, McCreath C, Graham C, Murchison JT (2007) Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax 62(6):536–540. https://doi.org/10.1136/thx.2006.062299
Streiff MB, Holmstrom B, Ashrani A, et al. (2015) Cancer-Associated Venous Thromboembolic Disease, Version 1.2015. J Natl Compr Cancer Netw 13(9):1079–1095
Chiu V, O’Connell C (2017) Management of the Incidental Pulmonary Embolism. Am J Roentgenol 208(3):485–488. https://doi.org/10.2214/ajr.16.17201
Yoo HH, Queluz TH, El Dib R (2016) Anticoagulant treatment for subsegmental pulmonary embolism. Cochrane Database Syst Rev (1):CD010222. https://doi.org/10.1002/14651858.cd010222.pub3
Rooden CJ, Tesselaar ME, Osanto S, Rosendaal FR, Huisman MV (2005) Deep vein thrombosis associated with central venous catheters - a review. J Thromb Haemost 3(11):2409–2419. https://doi.org/10.1111/j.1538-7836.2005.01398.x
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kalisz, K., Enzerra, M. & Ansari-Gilani, K. Cardiovascular findings on cross-sectional imaging: spectrum of incidental and critical findings and clinical relevance for the abdominal radiologist. Abdom Radiol 44, 1161–1180 (2019). https://doi.org/10.1007/s00261-019-01922-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-019-01922-7