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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
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Things We Do for No Reason™: Overlooking incidental coronary artery calcification (iCAC)
Kristie J Sun1,2, Seamus P Whelton3, Leonard Feldman3
1Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Journal of Hospital Medicine
|August 29, 2025
Summary
Incidental coronary artery calcium (iCAC) found on CT scans for COVID-19 may indicate future heart attack risk. Early detection and management of iCAC are crucial for preventing cardiovascular events.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- COVID-19 can cause hypoxemia, necessitating imaging like chest CT.
- Incidental findings on medical imaging, such as coronary artery calcium (CAC), are common.
- The clinical significance of incidentally detected CAC in patients with COVID-19 is not well-established.
Purpose of the Study:
- To highlight the importance of recognizing and acting upon incidental coronary artery calcium (iCAC) detected during COVID-19 evaluations.
- To underscore the potential link between untreated iCAC and subsequent acute myocardial infarction (AMI).
Main Methods:
- A case report detailing a patient's presentation with COVID-19 and hypoxemia.
- Review of a non-contrast chest CT scan that revealed ground-glass opacities and moderate iCAC.
- Analysis of the patient's clinical course following discharge without specific management for iCAC.
Main Results:
- A 58-year-old man with COVID-19 had moderate iCAC noted on chest CT but was discharged without follow-up for this finding.
- Eighteen months post-discharge, the patient experienced an acute myocardial infarction.
- This case suggests a potential association between unaddressed iCAC and future cardiac events.
Conclusions:
- Incidental coronary artery calcium detected on chest CT for COVID-19 should not be overlooked.
- Failure to address iCAC may lead to adverse cardiovascular outcomes, including myocardial infarction.
- Recommendations for managing incidental CAC in the context of acute respiratory illness are needed.
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