Incidental findings on cardiac CTs By Dr Scott Claxton, Respiratory Physician, Joondalup Jennifer is 63 and complained of chest pain. She has a family history of ischaemic heart disease and a history of intermittent smoking for a few years. A CT calcium score didn’t show any coronary artery calcification but an incidental ground-glass nodule was seen in her left upper lobe (Fig 1).
other times they may be early stage disease or entirely benign. Incidental imaging of the lung fields brings them to attention. In turn the lung abnormality will need to be assessed on its own merits. Cardiac disease and respiratory disease share risk factors (smoking, increased age) and so abnormality in both is to be expected.
This was followed up over a twoyear period when it showed the development of a solid component (Fig 2).She was referred for resection and pathology identified an adenocarcinoma. CT-based investigation for diagnosing coronary artery disease and assessment of cardiac risk is increasing. As a result, coincidental imaging of the lung fields is also increasing. This has led to increased identification of clinically silent but not necessarily clinically irrelevant, non-cardiac abnormalities. These can comprise findings in the chest wall, breasts, skeleton, lung, pulmonary vasculature, mediastinum and non-coronary vasculature. Some will be clearly significant requiring prompt assessment. For others, the shortand long-term risk is not so clear and follow-up probably with further imaging will be required. Even in health, the respiratory
Fig 1.
system is exposed to numerous, potentially irritating or noxious challenges. Respiratory infection is common and over time these can lead to abnormalities in lung tissue that may be identifiable radiologically. With normal ageing comes changes in lung function and histology, a loss of elastic recoil, increased collagen deposition, loss of small airway supports. In addition, other more well-defined factors can impact on lung structure and function (cigarette smoke, pollution, asbestos etc.). While sometimes these may cause symptoms and be recognised,
Non-cardiac (and for the purposes of this discussion – pulmonary) incidental findings on cardiac CTs are generally grouped as either significant or non-significant. The former can include lung nodules and masses, pulmonary emboli, aortic abnormalities, breast masses, pleural masses and effusions. Non-significant, or perhaps better referred to as less immediately significant, findings include emphysematous change, small (<6mm nodules), pleural thickening, interstitial lung abnormalities. In one large study of 2050 scans, 5% had significant, non-cardiac findings. The most common were lung nodule (<3cm) or lung mass (>3cm). In a patient with a history of cigarette smoke exposure there is the concern that these lesions may represent early malignancy. For
Rethinking mental health in COVID-19 continued from Page 39 Every consultation is the chance to ask, “how are things going for you, really?” Remembering to check in on a person especially if they live alone, have little social support, have lost their job or are finding the ongoing situation increasingly difficult to manage. Doctors can provide accurate and trustworthy information to combat the hype, misinformation and conspiracy theories and reaffirm the positive aspect of healthy lifestyle choices.
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Use a brief questionnaire (e.g. Short Warwick-Edinburgh Mental Wellbeing Scale) and or subjective wellbeing questionnaire as a form of rapid assessment of mental wellbeing. Evaluate wellbeing on the basis of how people feel and function on a personal and social level, and how they evaluate their lives as a whole. Provide additional ongoing support via telehealth. This facilitates tracking patient progress, especially for those previously diagnosed with complex or severe mental health
challenges or considered vulnerable to poorer mental health. Making mental wellbeing part of a regular health check has the potential to reduce the prevalence of mood disorders in our community. Now that would be something to celebrate. Author competing interests - nil
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