Incidental Cardiac & Vascular Findings

Pericardial Sac

Normal ranges Normal pericardial fluid is approximately 15-30 mL; up to about 50 mL may be physiologic. Normal pericardial thickness is <=2 mm; thickness >3-4 mm is abnormal.

Report

  • Apparent effusion volume: trace/small versus moderate/large.
  • Pericardial thickening, calcification, nodularity, or enhancement when present.
  • Presence, size, location, and attenuation of a pericardial mass or cyst.
  • Pericardial recess fluid is common and should not be mistaken for lymphadenopathy.

Management cues

  • Small nonspecific effusions are common and usually need no imaging work-up.
  • Large effusions warrant reporting and clinical correlation.
  • Simple pericardial cysts are typically benign and need no further imaging unless large or symptomatic.
  • Large cyst, thickened pericardium, unexplained large effusion, or suspected constrictive/acute pericarditis may prompt MRI, short-term CT, or cardiology evaluation.

Aorta / Pulmonary Artery

Measure and localize Report maximal vascular diameter and the involved segment. Use dedicated aortic guidance for detailed surveillance and intervention decisions.

Thoracic aorta

  • Average ascending aorta is roughly 34 mm in men and 32 mm in women; descending aorta roughly 26 mm in men and 23 mm in women.
  • Dilation/ectasia is generally >2 SD above expected normal, adjusted for age, sex, and body size.
  • Aneurysm is conventionally >=150% of expected normal, roughly 5.0 cm ascending or 4.0 cm descending.
  • Diameters >=5.5 cm carry high rupture risk and should be considered for intervention; lower thresholds may apply in connective tissue disease.
  • Open thoracic aorta aneurysm reference

Pulmonary artery dilation

  • Main pulmonary artery diameter >=3.0 cm or equal to/larger than the ascending aorta should be reported as dilated.
  • Framingham reference cutoffs are about 29 mm in men and 27 mm in women; MPA/ascending aorta ratio >=0.91 is abnormal.
  • MPA >29-31.5 mm or MPA/aorta ratio >1.0 supports possible pulmonary hypertension.
  • Comment on pulmonary emboli, chronic thromboembolic disease, advanced lung disease, fibrosis, or cardiac disease when present.

Coronary Calcium / Reporting

Core recommendation Coronary artery calcification should be reported on all noncontrast chest CTs, regardless of indication or risk profile.

CAC burden

  • CAC is common on noncardiac chest CT and reflects atherosclerotic plaque burden.
  • Acceptable methods on nongated CT include Agatston scoring, ordinal scoring, or visual assessment.
  • Visual categories: none, mild, moderate, severe/heavy.
  • Agatston categories: 0 = very low risk; 1-100 = mild; 101-300 = moderate; >300 = high.
  • Heavy/severe CAC should prompt cardiovascular risk assessment and management discussion.

Useful report language

  • No coronary artery calcification.
  • Mild coronary artery calcification.
  • Moderate coronary artery calcification.
  • Severe coronary artery calcification.
  • Main pulmonary artery is dilated, which can be seen with pulmonary hypertension.

Sources

Secondary Links

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