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Background: We recently reported 6 cases of pulmonary/hilar malignancies as the result of incidental findings (IF) on CT attenuation correction (CTAC) during SPECT-CT MPI. In this study, we examined clinical features, diagnostic procedures and clinical outcome on all patients who were had malignancies or significant IF that required further follow-up.  Methods: Of 1098 consecutive patients who underwent cardiac SPECT-CT MPI from 9/1/2017 to 8/31/2018, their MPI and CTAC were reviewed contemporaneously.  Patients with known history of prior pulmonary or chest malignancy were excluded.  Results: A total of 79 (7.2%) patients were identified to have significant IF on CTAC; after diagnostic CT, 47 patients were found to have significant findings that warranted further follow-up and included in this study. Eight patients (0.73%) were found to have malignancy of the chest because of IF on the CTAC.   There was no statistical difference in baseline characteristics and cancer risk factors among patients who were found to have cancer vs those without.  At the time of diagnosis, 4 patients were found to have cancer at advanced stage who all died within 12 months while 3 others had lung cancer of early stage and 1 mantle cell lymphoma were alive at a mean follow-up of 17.5+/-2.1 months. Biopsy for tissue diagnosis were performed safely: with needle biopsy, major complication occurred in 1 patient (1/9 or 11.1%); none with surgical biopsy. Conclusions: This study underscores the importance of reviewing CTAC images obtained during cardiac SPECT-CT MPI to potentially detect clinically important incidental findings.

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Abdominal computed tomography (CT) was obtained in a patient for evaluation of a colon mass. The CT showed a slight dilatation of the right renal pelvis with no hydronephrosis, but inguinal herniation of the right ureter, which was dilated to 7 mm and looped inside the inguinal hernia with enlarged insert on the left (highlighted in the Figure within the white box and shown to the right). The arrow in the Figure insert points to the herniated and dilated right ureter.

INTRODUCTION Incidence of thoracic aortic dissection (TAD) in the general population is very low, ranging from 2.6-3.5 cases per 100,000 persons per year, but it is associated with a high rate of mortality and morbidity. 1-3 Based on the nature of its onset and anatomical location, TAD is classified as either acute or chronic Stanford type-A dissection involving the ascending aorta and type-B distal to the left subclavian artery. 4,5 Acute type-A dissection is highly lethal with a 30-day mortality of 50% compared to 10% of type B. 2 Most acute TAD patients presented with a sudden onset of severe chest, abdominal, or back pain, but 6.4% of them may have painless dissection. 6 The majority of patients with TAD were older with a mean age of 63 years while only 7% of them were less than 40 years of age. 7 Common predisposing factors for TAD are hypertension, atherosclerosis, and a history of cardiac surgery 2 , while in young patients they are more likely Marfan's syndrome, bicuspid aortic valve, and prior aortic surgery. 7 We report a case of a healthy, young male veteran who presented with asymptomatic, chronic type-A dissection of a large aortic aneurysm, complicated by severe aortic regurgitation (AR). Several physical signs characteristic of chronic, severe AR were found in this patient.