title: Extracardiac findings on routine echocardiographic examinations.
abstract: BACKGROUND
  Incidental extracardiac findings (ECFs) have been described and studied in myocardial perfusion imaging, cardiac computed tomography, and cardiac magnetic resonance scanning. The literature is surprisingly limited with regard to ECFs in echocardiography. The aim of this study was to evaluate the prevalence and the clinical significance of ECFs in routine echocardiographic studies.
  
  
  METHODS
  The literature in other cardiovascular modalities was searched to identify and classify ECFs. ECFs in reports of transthoracic and transesophageal echocardiographic studies performed at Temple Health Network between 2009 and 2011 were sought. A sensitivity analysis was performed by reviewing the actual echocardiographic images for a subset of studies (n = 350) to determine the sensitivity and specificity of the results. The electronic medical records of patients with ECFs on echocardiography were then retrospectively reviewed, except for those with pleural effusions and descending aortic atheroma.
  
  
  RESULTS
  A total of 41,067 echocardiographic studies performed between September 2008 and September 2011 (39,269 transthoracic and 1,798 transesophageal studies) were screened. Of these studies, 66.5% were performed in the inpatient setting and 33.5% in the outpatient setting. The prevalence of ECFs was 4.4% (1,797 findings) and was constant during the study years. Pleural effusion was the most common ECF on transthoracic echocardiography, while descending aortic atheroma was the most common ECF on transesophageal echocardiography. Detailed chart reviews were performed in all patients with ECFs, except those with pleural effusion and descending aortic atheroma (351 cases). ECFs on echocardiography led to new diagnoses and altered management in the majority of patients with vascular or liver findings.
  
  
  CONCLUSIONS
  In this large consecutive series, ECFs on echocardiography were relatively uncommon and had variable clinical implications. The majority or ECFs are likely low-risk findings (pleural effusion, ascites, and hiatal hernia) and can be managed conservatively. "Higher risk" findings such as liver abnormalities, inferior vena cava filling defects, mediastinal masses, and descending aortic dilatation frequently lead to significant changes in clinical management. There is a need for uniform reporting, appropriate training, and the establishment of national guidelines for ECFs on echocardiography.
authors.affiliation: Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania. Electronic address: adnanalkhouli@gmail.com.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alkhouli
authors.affiliation: Department of Internal Medicine, Boston University, Boston, Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Sandhu
authors.affiliation: Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
authors.affiliation: Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Pravin
authors.initials: P
authors.lastname: Patil
authors.affiliation: Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Panidis
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amit
authors.initials: A
authors.lastname: Pursnani
mesh_terms: D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Ascites; Cardiovascular imaging; Descending aortic dilatation; ECG; Echocardiography; Extracardiac findings; Extracardiac mass; Liver mass; Pleural effusion