Incidental Cardiovascular Findings in Lung Cancer Screening and Noncontrast Chest Computed Tomography

While the primary goal of lung cancer screening CT is to detect early-stage lung cancer in high-risk populations, it often reveals asymptomatic cardiovascular abnormalities that can be clinically significant. These findings include coronary artery calcifications (CACs), myocardial pathologies, cardiac chamber enlargement, valvular lesions, and vascular disease. CAC, a marker of subclinical atherosclerosis, is particularly emphasized due to its strong predictive value for cardiovascular events and mortality. Guidelines recommend qualitative or quantitative CAC scoring on all noncontrast chest CTs. Other actionable findings include aortic aneurysms, pericardial disease, and myocardial pathology, some of which may indicate past or impending cardiac events. This article explores the wide range of incidental cardiovascular findings detectable during low-dose CT (LDCT) scans for lung cancer screening, as well as noncontrast chest CT scans. Distinguishing which findings warrant further evaluation is essential to avoid overdiagnosis, unnecessary anxiety, and resource misuse. The article advocates for a structured approach to follow-up based on the clinical significance of each finding and the patient’s overall risk profile. It also notes the rising role of artificial intelligence in automatically detecting and quantifying these abnormalities, potentiating early behavioral modification or medical and surgical interventions. Ultimately, this piece highlights the opportunity to reframe LDCT as a comprehensive cardiothoracic screening tool.