Beyond the heart: a pictorial review of extracardiac findings on cardiac CT.

Cardiac computed tomography (CT) is a cornerstone imaging modality for the diagnosis and management of cardiovascular disease, with widespread applications from the evaluation of chest pain to planning a wide range of minimally invasive procedures. The field of view obtained during imaging includes the heart and surrounding structures, including pericardium, thoracic great vessels, mediastinum, lungs, bones, and upper abdomen. Extracardiac findings have been reported in up to 61% of patients evaluated for chest pain, highlighting the importance of carefully analyzing and evaluating extracardiac structures. False positive interpretation leads to additional downstream testing, increasing health care costs and patient anxiety. Conversely, false negative interpretation, resulting in missed diagnoses, may pose even greater risk to patients. This review article provides a structured approach to evaluate for extracardiac findings on cardiac CT. With a rapid expansion of cardiac CT utilization, endorsed by multiple cardiovascular guidelines, it is imperative to establish and uphold standardized interpretation protocols for extracardiac findings that may have important clinical implications for patient care.