Management of Incidental Mediastinal and Cardiovascular Findings on Thoracic CT

Based on recommendations by the American College of Radiology (ACR), published as guidelines (white papers)
incidental - Thoracic
Which incidental & asymptomatic finding have you identified?
What is the location of the finding?
Is the mass cystic?
Further evaluation with MRI
Further evaluation with MRI or PET/CT
Which one best describes the pericardial finding?
Which of the following is applicable to the finding?
Does the patient have a condition that would explain this finding?
No further work-up
Further management depends on the primary disease
Clinical consultation and/or PET/CT and/or follow-up with chest CT in 3-6 months
On the follow-up CT, if the lymph node is enlarged, consider PET/CT or biopsy. If the size is stable or decreased, no further work-up is needed.
Consider MRI or short-term follow-up CT

Click here to visit the incidental findings page on ACR.

References:

  1. Munden, R. F., Carter, B. W., Chiles, C., MacMahon, H., Black, W. C., Ko, J. P., McAdams, H. P., Rossi, S. E., Leung, A. N., Boiselle, P. M., Kent, M. S., Brown, K., Dyer, D. S., Hartman, T. E., Goodman, E. M., Naidich, D. P., Kazerooni, E. A., Berland, L. L., & Pandharipande, P. V. (2018). Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology : JACR, 15(8), 1087–1096. https://doi.org/10.1016/j.jacr.2018.04.029

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