Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy -
Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
J Cardiovasc Surg (Torino). 2022 Oct;63(5):606-613. doi: 10.23736/S0021-9509.22.12278-0. Epub 2022 Jun 22.
Unenhanced chest CT can identify incidental findings (IFs) leading to management strategy change. We report our institutional experience with routine chest-CT as preoperative screening tool during the COVID-19 pandemic, focusing on the impact of IFs.
All patients scheduled for cardiac surgery from May 1st to December 31 2020, underwent preoperative unenhanced chest-CT according to COVID-19 pandemic institutional protocol. We have analyzed IFs incidence, reported consequent operative changes, and identified IFs clinical determinants.
Out of 447, 278 patients were included. IFs rate was 7.2% (20/278): a solid mass (11/20, 55%), lymphoproliferative disease (1/20, 5%), SARS-CoV-2 pneumonia (2/20, 10%), pulmonary artery chronic thromboembolism (1/20, 5%), anomalous vessel anatomy (2/20, 10%), voluminous hiatal hernia (1/20, 5%), mitral annulus calcification (1/20, 5%), and porcelain aorta (1/20, 5%) were reported. Based on IFs, 4 patients (20%-4/278, 1.4%) were not operated, 8 (40%-8/278, 2.9%) underwent a procedure different from the one originally planned one, and 8 (40%-8/278, 2.9%) needed additional preoperative investigations before undergoing the planned surgery. At univariate regression, coronary artery disease, atrial fibrillation, and history of cancer were significantly more often present in patients presenting with significant IFs. History of malignancy was identified as the only independent determinant of significant IFs at chest-CT (OR=4.27 IQR: [1.14-14.58], P=0.0227).
Unenhanced chest-CT as a preoperative screening tool in cardiac surgery led to incidental detection of significant clinical findings, which justified even procedures cancellation. Malignancy history is a determinant for CT incidental findings and could support a tailored screening approach for high-risk patients.
未增强的胸部 CT 可以识别导致管理策略改变的偶然发现（IFs）。我们报告了在 COVID-19 大流行期间，将常规胸部 CT 作为术前筛查工具的机构经验，重点关注 IFs 的影响。
所有计划在 2020 年 5 月 1 日至 12 月 31 日期间进行心脏手术的患者，均根据 COVID-19 大流行机构方案接受术前未增强的胸部 CT。我们分析了 IFs 的发生率，报告了随之而来的手术变化，并确定了 IFs 的临床决定因素。
在 447 例患者中，有 278 例患者被纳入研究。IFs 的发生率为 7.2%（20/278）：实性肿块（11/20，55%）、淋巴增殖性疾病（1/20，5%）、SARS-CoV-2 肺炎（2/20，10%）、肺动脉慢性血栓栓塞症（1/20，5%）、异常血管解剖（2/20，10%）、巨大食管裂孔疝（1/20，5%）、二尖瓣环钙化（1/20，5%）和瓷主动脉（1/20，5%）。根据 IFs，有 4 名患者（20%-4/278，1.4%）未接受手术，8 名患者（40%-8/278，2.9%）接受了不同于最初计划的手术，8 名患者（40%-8/278，2.9%）需要在接受计划手术前进行额外的术前检查。在单变量回归中，冠状动脉疾病、心房颤动和癌症史在出现显著 IFs 的患者中更为常见。癌症史被确定为胸部 CT 偶然发现的唯一独立决定因素（OR=4.27 IQR：[1.14-14.58]，P=0.0227）。
未增强的胸部 CT 作为心脏手术的术前筛查工具，导致了偶然发现的显著临床发现，这甚至导致了手术的取消。恶性肿瘤病史是 CT 偶然发现的决定因素，并可以支持对高危患者进行针对性筛查。
