Significance of cardiac computed tomography incidental findings in acute chest pain.
BACKGROUND
Coronary computed tomography angiography might improve the management of patients presenting to the emergency department with acute chest pain; however, noncoronary incidental findings are frequently detected. The prevalence and clinical significance of these findings have not been well described.


METHODS
Consecutive patients presenting to the emergency department with acute chest pain and inconclusive initial evaluation between May 2005 and May 2007 underwent 64-slice coronary computed tomography angiography before hospital admission with noncoronary incidental findings immediately reported. An expert panel adjudicated which incidental findings changed in-hospital patient management, and projections for additional testing were based on standard medical practice.


RESULTS
Among 395 patients (37.0% were female, mean age 53 +/- 12 years), incidental findings were detected in 44.8% (n = 177): noncalcified pulmonary nodules (n = 94, 23.8%), simple liver cysts (n = 26, 6.6%), calcified pulmonary nodules (n = 16, 4.1%), and contrast-enhancing liver lesions (n = 9, 2.3%). In-hospital management was changed because of incidental finding reporting in 5 patients (1.3%), and a potential alternative diagnosis was offered in another 16 patients (4.1%). Subsequent diagnostic imaging tests were recommended in 81 patients (20.5%), including 74 chest computed tomography scans. After 6 months, biopsy was performed in 3 patients, revealing cancer in 2 (0.5%) who underwent successful tumor resection.


CONCLUSIONS
Clinically important findings are detected in up to 5% of patients with a lead symptom of acute chest pain and low to intermediate likelihood of acute coronary syndrome, but only few directly change patient management; 21% are recommended for further imaging tests, resulting in invasive procedures and detection of cancer in few patients.
Lehman
Sam J
SJ
Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts 02114, USA.
Abbara
Suhny
S
Cury
Ricardo C
RC
Nagurney
John T
JT
Hsu
Joe
J
Goela
Aashish
A
Schlett
Christopher L
CL
Dodd
Jonathan D
JD
Brady
Thomas J
TJ
Bamberg
Fabian
F
Hoffmann
Udo
U
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods; D003560:Cysts / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008107:Liver Diseases / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed