Incidental vascular findings on CT pulmonary angiography (CTPA)

CT pulmonary angiography (CTPA) is being used increasingly as a diagnostic modality for patients with suspected pulmonary embolism (PE). CTPA frequently reveals incidental findings that may explain the patient’s presentation. These findings could be parenchymal, pleural, or vascular. The aim of this study was to evaluate the spectrum of incidental vascular findings and their significance. A retrospective review was done on 508 CTPAs of adults with suspicion of PE in the University of Missouri between June and December of 2009. Forty-three scans were excluded because of motion artifacts or poor contrast. Of the total 465 scans, 39% (180/465) scans were done in the emergency room. Calcification of the aorta and coronary arteries was the most common finding 27% (124/465), followed by dilatation of the pulmonary trunk 3.4% (16/465) and thoracic aortic aneurysms 1.5% (7/465). Four cases of aberrant right subclavian artery were found. The rest of the findings were rare and were detected in only one or two patients. CTPA delineates vascular findings other than PE. The majority of these findings are not acute, but warrant recognition and follow up. In less than 1% of the cases, aortic dissection is detected, which might explain the patient’s presentation.