title: Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease.
abstract: BACKGROUND
  CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans.
  
  
  OBJECTIVE
  To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease.
  
  
  METHODS
  During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts.
  
  
  RESULTS
  Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients.
  
  
  CONCLUSIONS
  Non-cardiovascular findings are common in children with congenital heart disease who undergo CT angiography. Based upon our study population, if a child with congenital heart disease has a CT angiography, five out of six will have non-cardiovascular findings, while nearly three out of four (73.7%; 221 / 300) will have significant non-cardiovascular findings. Close attention to the non-cardiovascular structures in children with congenital heart disease presenting for a CT angiography is recommended as in nearly 40% of these children, findings were unexpected and directly altered patient care.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
authors.forename: Archana
authors.initials: A
authors.lastname: Malik
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|New York Cardiovascular Institute at Lenox Hill Radiology, New York, NY, USA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Hellinger
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Sabah
authors.initials: S
authors.lastname: Servaes
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Sanger Heart and Vascular Institute, Levine Children's Hospital, Charlotte, NC, USA.
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Schwartz
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. monica.epelman@nemours.org.|Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA. monica.epelman@nemours.org.
authors.forename: Monica
authors.initials: M
authors.lastname: Epelman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D033162:Incidental Findings; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies
keywords: Children; Computed tomography angiography; Congenital heart disease; Extracardiac findings; Non-cardiovascular findings