Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

Abstract

Aim: To validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.

Methods: We conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years' experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.

Results: There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.

Conclusion: HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.

Keywords: Aorta; Cigarette smoking; Computed tomography angiography; Endovascular aortic aneurysm repair; Lung cancer.

Figure 1

Lepidic predominant adenocarcinoma diagnosed during endovascular aortic aneurysm repair follow-up. A-C: A 80-year-old male with a LPA of the right upper lobe diagnosed during endovascular aortic aneurysm repair follow-up for a type II endoleak treated with glue and coils (A). HRCT images (B and C) demonstrate the lepidic growth of the tumor and aerogenous metastases in the same lobe. LPA: Lepidic predominant adenocarcinoma; HRCT: High resolution computed tomography.

Figure 2

Breast cancer lung metastasis diagnosed during endovascular aortic aneurysm repair planning. A-C: A-63-year-old woman, with a history of breast cancer (10 year before, pT1cN0M0), addressed to our institution for vascular planning due to an abdominal aortic aneurism (A). HRCT image (B) performed before the contrast media administration showed diffuse enphysema in upper lobes and the presence in the left upper lobe of a solid nodule (18 mm) with spiculated margins and bronchus sign, confirmed at small FOV reconstruction (C). Histological evaluation, after surgical intervention, demonstrated a breast cancer lung metastasis. HRCT: High resolution computed tomography.