التفاصيل البيبلوغرافية
| العنوان: |
Significance of Cardiac Computed Tomography Incidental Findings in Acute Chest Pain |
| المؤلفون: |
Lehman, Sam J.1,2, Abbara, Suhny1,3, Cury, Ricardo C.1,3, Nagurney, John T.4, Hsu, Joe1,3, Goela, Aashish3, Schlett, Christopher L.1, Dodd, Jonathan D.1,3, Brady, Thomas J.1,3, Bamberg, Fabian1,3, Hoffmann, Udo1,3 uhoffmann@partners.org |
| المصدر: |
American Journal of Medicine. Jun2009, Vol. 122 Issue 6, p543-549. 7p. |
| مصطلحات موضوعية: |
*TOMOGRAPHY, *CHEST disease diagnosis, *CHEST pain, *MEDICAL emergencies |
| مستخلص: |
Abstract: Background: Coronary computed tomography angiography might improve the management of patients presenting to the emergency department with acute chest pain; however, noncoronary incidental findings are frequently detected. The prevalence and clinical significance of these findings have not been well described. Methods: Consecutive patients presenting to the emergency department with acute chest pain and inconclusive initial evaluation between May 2005 and May 2007 underwent 64-slice coronary computed tomography angiography before hospital admission with noncoronary incidental findings immediately reported. An expert panel adjudicated which incidental findings changed in-hospital patient management, and projections for additional testing were based on standard medical practice. Results: Among 395 patients (37.0% were female, mean age 53 ± 12 years), incidental findings were detected in 44.8% (n = 177): noncalcified pulmonary nodules (n = 94, 23.8%), simple liver cysts (n = 26, 6.6%), calcified pulmonary nodules (n = 16, 4.1%), and contrast-enhancing liver lesions (n = 9, 2.3%). In-hospital management was changed because of incidental finding reporting in 5 patients (1.3%), and a potential alternative diagnosis was offered in another 16 patients (4.1%). Subsequent diagnostic imaging tests were recommended in 81 patients (20.5%), including 74 chest computed tomography scans. After 6 months, biopsy was performed in 3 patients, revealing cancer in 2 (0.5%) who underwent successful tumor resection. Conclusion: Clinically important findings are detected in up to 5% of patients with a lead symptom of acute chest pain and low to intermediate likelihood of acute coronary syndrome, but only few directly change patient management; 21% are recommended for further imaging tests, resulting in invasive procedures and detection of cancer in few patients. [Copyright &y& Elsevier] |
| قاعدة البيانات: |
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