Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know

Fig. 1. a Large ostium secundum ASD (black arrow) in a 51-year old female who was being investigated for cause of pulmonary hypertension. RA right atrium, LA left atrium. b The patient also had large central pulmonary arteries demonstrated by thoracic CT. MPA main pulmonary artery

Fig. 2. Oblique sagittal reformatted image showing a “tubular” type of PDA, which was an incidental finding in a 52-year male patient being worked up for pulmonary embolism. AO aorta, PA pulmonary artery. This study was ECG gated and was probably a “double rule out” study to evaluate for pulmonary embolism and Aortic disease

Fig. 3. Sinus of Valsalva aneurysm (SOVA) of the non-coronary sinus on an axial contrast enhanced thoracic CT in a 59-year old male being evaluated for thoracic neoplasm. SVA sinus of Valsalva aneurysm

Fig. 4. Axial contrast CT shows a bicuspid aortic valve (black arrows) in a 62-year old man being worked up for a widened mediastinum. The valve leaflets are thickened and calcified

Fig. 5. a Axial contrast enhanced CT image demonstrating a coronary artery aneurysm (a) of the left anterior descending coronary artery (black arrow) in a 56-year-old female who was being evaluated for aortic disease. b Multiplanar reformatted images in the sagittal oblique plane also demonstrate the aneurysm (a) of the left anterior descending coronary artery (black arrow). A aneurysm, AO aorta, PA pulmonary artery, LA left atrium, LSPV left superior pulmonary vein. Please note that this examination was an ECG gated aortic CTA, but images were included as it was such a good example of coronary artery aneurysm

Fig. 6. a, b A 62-year-old woman being evaluated for weight loss. a Axial thick slab maximum intensity projection (MIP) CT image shows the coronary artery fistula (white arrow) arising from the left anterior descending coronary artery (black arrow). b Axial CT image shows the coronary artery fistula emptying into the main pulmonary artery (white arrow). Please note that this examination was an ECG gated aortic CTA, but images were included as it was such a good example of coronary artery fistula

Fig. 7. Axial contrast enhanced CT demonstrates the RCA (black arrow) arising from the left coronary cusp in a 43-year-old female being evaluated for hoarseness and vocal cord paralysis. Ao aorta, PA pulmonary artery

Fig. 8. a Axial contrast-enhanced CT demonstrates a left ventricular true aneurysm (white arrowheads) in a 71-year-old male who was being evaluated for empyema. He had a history of myocardial infarction. b Axial CT image through the chest demonstrates a left ventricular pseudoaneurysm with a narrow neck (black arrow) in a young male being evaluated for fever and chest pain. LA left atrium, RA right atrium, LV left ventricle, PsA pseudoaneurysm. c Axial CT image through the lower chest and upper abdomen demonstrates a small apical left ventricular diverticulum (asterisk) in a 55-year-old male being evaluated for thoracic neoplasm. LLL left liver lobe, RV right ventricle

Fig. 9. Axial contrast-enhanced CT demonstrates dilated cardiomyopathy (DCM) on an axial contrast enhanced image in a 65-year-old man being evaluated for PE

Fig. 10. a Axial contrast-enhanced CT demonstrates left ventricular hypertrophy (LVH) on an axial contrast enhanced image in a 70-year-old man being evaluated for back pain. b Sagittal oblique multiplanar reformatted MPR images (short axis) demonstrate concentric hypertrophy of the left ventricular wall

Fig. 11. Axial contrast enhanced CT demonstrates the asymmetric form of hypertrophic cardiomyopathy (HCM) on an axial contrast enhanced image (with anteroseptal or mid ventricular thickening) and anatomic narrowing of the left ventricular outflow tract (LVOT) in a 37-year-old female being evaluated for pulmonary embolus

Fig. 12. a, b Axial (a) and sagittal non-contrast CT image demonstrating curvilinear dystrophic calcification at the left ventricular apex in a 64-year-old female who was being evaluated for COPD. She had a history of previous myocardial infarct. b Axial non-contrast CT on bone window setting demonstrates metastatic myocardial calcification in the left ventricle in an 88-year-old woman with chronic renal impairment