@article {Kelion1461, author = {Andrew Kelion and Nikant Sabharwal and David Holdsworth and Sam Dawkins and Heiko Peschl and Anny Sykes and Yaver Bashir}, title = {Clinical and economic impact of extracardiac lesions on coronary CT angiography}, volume = {108}, number = {18}, pages = {1461--1466}, year = {2022}, doi = {10.1136/heartjnl-2021-320698}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective When reporting coronary CT angiography (CCTA), extracardiac structures are routinely assessed, usually on a wide field-of-view (FOV) reconstruction. We performed a retrospective observational cross-sectional study to investigate the impact of incidental extracardiac abnormalities on resource utilisation and treatment, and cost-effectiveness.Methods All patients undergoing CCTA at a single institution between January 2012 and March 2020 were identified. The indication for CCTA was chest pain or dyspnoea in \>90\%. Patients with >=1 significant extracardiac findings were selected. Clinical follow-up, investigations and treatment were documented, and costs were calculated.Results 4340 patients underwent CCTA; 717 extracardiac abnormalities were identified in 687 individuals (15.8\%; age 62{\textpm}12 years; male 336, 49\%). The abnormality was already known in 162 (23.6\%). Lung nodules and cysts were the most common abnormalities (296, 43.1\%). Clinical and/or imaging follow-up was pursued in 292 patients (42.5\%). Treatment was required by 14 patients (0.3\% of the entire population), including lung resection for adenocarcinoma in six (0.1\%). All but two abnormalities (both adenocarcinomas) were identifiable on the limited cardiac FOV. The cost of reporting ({\textsterling}20) and follow-up ({\textsterling}33) of extracardiac abnormalities was {\textsterling}53 per patient. The cost per discounted quality-adjusted life year was {\textsterling}23 930, increasing to {\textsterling}46 674 for reporting the wide FOV rather than the cardiac FOV alone.Conclusions Extracardiac abnormalities are common on CCTA, but identification and follow-up are costly. The few requiring treatment are usually identifiable without review of the wide FOV. The way in which CCTAs are scrutinised for extracardiac abnormalities in a resource-limited healthcare system should be questioned.Data are available on reasonable request.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/108/18/1461}, eprint = {https://heart.bmj.com/content/108/18/1461.full.pdf}, journal = {Heart} }