The American Journal of Medicine
Volume 122, Issue 6 , Pages 543-549 , June 2009

Significance of Cardiac Computed Tomography Incidental Findings in Acute Chest Pain

  • Sam J. Lehman, MBBS, FRACP

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Flinders University Department of Cardiology, Adelaide, Australia
    • ,
  • Suhny Abbara, MD

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • Ricardo C. Cury, MD

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • John T. Nagurney, MD, MPH

      Affiliations

    • Massachusetts General Hospital Department of Emergency Medicine and Harvard Medical School, Boston, Massachusetts
    • ,
  • Joe Hsu, MD

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • Aashish Goela, MD

      Affiliations

    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • Christopher L. Schlett, BS

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • ,
  • Jonathan D. Dodd, MD

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • Thomas J. Brady, MD

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • Fabian Bamberg, MD, MPH

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • ,
  • Udo Hoffmann, MD, MPH

      Affiliations

    • Massachusetts General Hospital Cardiac MR PET CT Program and Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital Department of Radiology, Boston, Massachusetts
    • Corresponding Author InformationRequests for reprints should be addressed to Udo Hoffmann, MD, MPH, Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Charles River Plaza, Suite 400, Boston, MA 02114

References 

  1. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey 2003 (Emergency Department Summary: Advance Data from Vital and Health Statistics, No. 358). Hyattsville, MD: National Center for Health Statistics; 2005;
  2. Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med. 2000;342:1187–1195
  3. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005;294:2623–2629
  4. Fineberg HV, Scadden D, Goldman L. Care of patients with a low probability of acute myocardial infarction (Cost effectiveness of alternatives to coronary-care-unit admission). N Engl J Med. 1984;310:1301–1307
  5. Tosteson AN, Goldman L, Udvarhelyi IS, Lee TH. Cost-effectiveness of a coronary care unit versus an intermediate care unit for emergency department patients with chest pain. Circulation. 1996;94:143–150
  6. Hoffmann U, Nagurney JT, Moselewski F, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation. 2006;114:2251–2260
  7. Rubinshtein R, Halon DA, Gaspar T, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation. 2007;115:1762–1768
  8. Goldstein JA, Gallagher MJ, O'Neill WW, et al. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863–871
  9. Haller S, Kaiser C, Buser P, et al. Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings. AJR Am J Roentgenol. 2006;187:105–110
  10. Illes J, Kirschen MP, Edwards E, et al. Ethics (Incidental findings in brain imaging research). Science. 2006;311:783–784
  11. Stone JH. Incidentalomas—clinical correlation and translational science required. N Engl J Med. 2006;354:2748–2749
  12. Horton KM, Post WS, Blumenthal RS, Fishman EK. Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations. Circulation. 2002;106:532–534
  13. Onuma Y, Tanabe K, Nakazawa G, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol. 2006;48:402–406
  14. Takakuwa KM, Halpern EJ. Evaluation of a “triple rule-out” coronary CT angiography protocol: use of 64-section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. Radiology. 2008;248:438-436
  15. MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. 2005;237:395–400
  16. Dewey M, Schnapauff D, Teige F, Hamm B. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging. Eur Radiol. 2007;17:2038–2043
  17. Hunold P, Schmermund A, Seibel RM, et al. Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification. Eur Heart J. 2001;22:1748–1758
  18. Schragin JG, Weissfeld JL, Edmundowicz D, et al. Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging. 2004;19:82–86
  19. Burt JR, Iribarren C, Fair JM, et al. Incidental findings on cardiac multidetector row computed tomography among healthy older adults. Arch Intern Med. 2008;168:756–761
  20. White CS, Kuo D, Kelemen M, et al. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation?. AJR Am J Roentgenol. 2005;185:533–540
  21. Johnson TRC, Nikolaou K, Wintersperger BJ, et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol. 2007;188:76–82
  22. Manghat NE, Morgan-Hughes GJ, Roobottom CA. Multi-detector row computed tomography: imaging in acute aortic syndrome. Clin Radiol. 2005;60:1256–1267
  23. Savino G, Herzog C, Costello P, Schoepf UJ. 64 slice cardiovascular CT in the emergency department: concepts and first experiences. Radiol Med (Torino). 2006;111:481–496
  24. Henschke CI, Yankelevitz DF, Libby DM, et al. International Early Lung Cancer Action Program Investigators Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006;355:1763–1771
  25. Bach PB, Jett JR, Pastorino U, et al. Computed tomography screening and lung cancer outcomes. JAMA. 2007;297:953–961
  26. Mueller J, Jeudy J, Poston R, et al. Cardiac CT angiography after coronary bypass surgery: prevalence of incidental findings. AJR Am J Roentgenol. 2007;189:414–419

 Funding: Dr Lehman is supported by grants from the National Heart Foundation of Australia and the Royal Australian College of Physicians.

 Conflict of Interest: None.

 Authorship: All authors had access to the data and played a role in writing.

PII: S0002-9343(08)01263-1

doi: 10.1016/j.amjmed.2008.10.039

The American Journal of Medicine
Volume 122, Issue 6 , Pages 543-549 , June 2009

Article Tools

* Image Usage & Resolution