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Background
In 2021, more than 866,000 patients in the United States completed annual lung cancer screening with noncontrast nongated chest CT (NCNGCCT). Due to advanced age and extensive smoking history, patients who undergo routine NCNGCCT are typically at high-to-intermediate risk for concurrent cardiovascular disease. In the National Lung Screening Trial, cardiovascular disease was identified as the most common cause of death in patients who underwent annual lung cancer screening; lung cancer represented the second most common cause of mortality. Although advancements in multidetector CT technology have facilitated the detection of clinically significant cardiovascular abnormalities on NCNGCCT, these findings are frequently under-reported. Previous studies suggest that aortic dilation and coronary artery calcification were not reported in 36% and 56% of cases, respectively. Incidental cardiovascular findings can significantly impact patient care, prompting medication adjustments, lifestyle modification, or screening for similar abnormalities in first-degree relatives. As a result, NCNGCCT provides an opportunity for radiologists to guide clinical decision making in a meaningful way. The purpose of this exhibit is to review key imaging features and management recommendations for important cardiovascular findings identified on NCNGCCT.

Educational Goals / Teaching Points
Our goal is to improve diagnosis and expedite management of clinically significant cardiovascular findings seen on NCNGCCT. For each incidental cardiovascular finding, we will review key imaging features, discuss differential diagnoses, and outline recommendations for next steps in management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will discuss several clinically significant cardiovascular findings identified on NCNGCCT. These cardiovascular abnormalities include bicuspid aortic valve and associated aortopathy, aortic aneurysm, aortic arch anomalies, pulmonary artery dilation, persistent left superior vena cava, aberrant coronary arteries, coronary artery calcification, and prior myocardial infarct.

Conclusion
Noncontrast nongated chest CT (NCNGCCT) is a valuable tool for the detection of important cardiovascular abnormalities. By understanding key imaging features and management recommendations for cardiovascular abnormalities, radiologists play an important role in guiding clinical decision-making for these incidental findings. Future research could explore the value of standardized reporting of cardiovascular findings on NCNGCCT and the possibility of utilizing NCNGCCT as a screening tool for detection of cardiovascular disease in patients with advanced age and extensive smoking history.