Cardiovascular findings on computed tomography in patients with unclear finding situation and trauma of unknown origin

Abstract

Incidental cardiovascular findings are common and can be found in up to 70% of patients. Previously, several reports about incidental findings (IFs) on whole body computed tomography (CT) were published. However, no previous study investigated cardiovascular IFs in patients with unclear finding situation and trauma of unknown origin on whole body CT.The radiological database of 2 university hospitals was screened for patients with trauma of unknown origin and unclear finding situation investigated by whole body CT. The images were retrospectively analyzed by 2 radiologists in consensus. The findings were classified according to their clinical relevance. Clinically nonrelevant findings like valvular sclerosis, aortic sclerosis, or anatomic variants were excluded from this study. Moreover, the radiology reports were analyzed to assess initial reporting by the radiologist.Overall, we identified 60 patients with a mean age of 63 years. A total of 98 clinically relevant cardiovascular IFs (CRCIF) were identified in 60 (75%) patients (1.6 CRCIF per patient). The most prevalent finding was cardiomegaly in 23 patients, followed by coronary sclerosis in 21 patients and aortic ectasia in 11 patients; other findings were rarer. Sixty-one findings were reported (62.2%) and 37 were nonreported (37.8%). Thirty patients (50%) showed no traumatic event on whole body CT.CRCIFs are common in patients with unclear finding situation and trauma of unknown origin. Despite initial indication for trauma detection, the whole body CT should carefully be evaluated for CRCIF because of the high prevalence of clinically relevant findings. Notably, 37.76% of the findings were not reported by the radiologist.

Dental Trauma on whole Body Trauma CT—An underreported finding

“…This dental finding was not reported by the radiologist. b The tooth fragment can also be appreciated in the axial plane It is not unusual that whole-body CT can detect numerous findings of the body with a high accuracy, comprising non-trauma-related incidental findings and possible hazardous trauma findings [10][11][12][13][14]. However, some dental findings might not be detectable by multidetector CT due to only subtle fracture lines [8].…”

“…Previously, various studies reported non-traumatic clinically relevant incidental findings in whole body CTs [11][12][13][14][15]. These comprise cardiovascular findings, incidental malignant tumors, or inflammation foci [11][12][13][14][15]. However, no study systematically investigated dental injuries on whole-body trauma CT despite its potential common occurrence.…”

Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications

“…Especially in patients suffering from high-energy trauma, whole-body CT (WBCT) scans are increasingly used and recommended by guidelines due to their real-time detection of acute traumatic injuries (ATI) with high specificity and sensitivity and their widespread availability [ 1 , 2 , 3 , 4 ]. However, besides their associated radiation exposure [ 1 , 2 ], WBCT scans are likely to reveal incidental findings (IF) unrelated to the preceding trauma [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Incidental findings are defined as recently unknown abnormalities revealed unintentionally in medical examinations.…”

“…Their severity varies from harmless findings to ones requiring urgent treatment and follow-up. Several studies have reported on the prevalence and impact of IFs in predominantly severely injured trauma patients who received WBCT or selective CT scans as initial emergency imaging modality [ 5 , 6 , 8 , 9 , 10 , 18 ]. The prevalence of IFs in different trauma patient populations varies from 30.4% to 75.3% [ 5 , 6 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 18 , 19 , 20 , 21 ], with more findings detected by means of WBCT than by selective CT scans [ 10 ].…”

“…Several studies have reported on the prevalence and impact of IFs in predominantly severely injured trauma patients who received WBCT or selective CT scans as initial emergency imaging modality [ 5 , 6 , 8 , 9 , 10 , 18 ]. The prevalence of IFs in different trauma patient populations varies from 30.4% to 75.3% [ 5 , 6 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 18 , 19 , 20 , 21 ], with more findings detected by means of WBCT than by selective CT scans [ 10 ]. An amount of 1% to 46.9% of IFs could have an impact on patients’ health and require urgent treatment or further examination [ 5 , 10 , 11 , 17 ].…”