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Updated: Sep 9, 2025

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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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
PubMed

Insights

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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