Incidental Distal Splenic Artery Aneurysm Detected on Coronary Computed Tomography Angiography Performed for Atypical Chest Pain: A Case Report

Coronary computed tomography angiography (CCTA) has become an established noninvasive modality for excluding obstructive coronary artery disease; however, its diagnostic value extends beyond the coronary arteries. Careful evaluation of the entire acquired field of view may reveal clinically important extracardiac abnormalities that would otherwise remain undetected. We report the case of a 63-year-old woman who presented with persistent atypical chest pain and multiple cardiovascular risk factors, including hypertension, obesity, physical inactivity, and daily hookah smoking. Electrocardiography and transthoracic echocardiography were unremarkable. CCTA demonstrated a coronary artery calcium score of 0, CAD-RADS 0, and normal coronary arteries without evidence of atherosclerosis or stenosis, effectively excluding a cardiac cause of her symptoms. Unexpectedly, meticulous review of the extracardiac structures identified a 11.5 × 11.1 mm saccular aneurysm arising from the distal splenic artery. The patient had no abdominal symptoms or known predisposing conditions, including pancreatitis or portal hypertension, making the aneurysm a truly incidental finding. She was referred to vascular surgery, where conservative management with imaging surveillance was recommended because of the aneurysm's small size and low-risk features. This case emphasizes that clinically significant diagnoses may lie outside the primary indication for imaging. Systematic assessment of all structures included on CCTA can uncover potentially life-threatening vascular abnormalities, influence subsequent management, and prevent missed opportunities for early diagnosis. Greater awareness of incidental extracardiac findings is essential to maximize the diagnostic yield and clinical value of coronary CT examinations.