Extra-cardiac findings

Abstract

Cardiovascular magnetic resonance (CMR) is an established, non-invasive technique to comprehensively assess cardiovascular structure and function in a variety of acquired and inherited cardiac conditions. In the process of acquiring CMR images, the inferior neck, entire thorax, and upper abdomen are routinely imaged, particularly in the initial multi-slice axial and coronal images. Identifying and reporting extra-cardiac findings at the time of CMR has ethical, financial, and medicolegal implications. Not all extra-cardiac findings are incidental, and occasionally they may contribute to the interpretation of the primary cardiac pathology, as some cardiac conditions have multi-systemic extra-cardiac involvement. However, the majority of extra-cardiac findings are incidental but may still be clinically important and may alter clinical management. Given that several of the cardiovascular risk factors for atherosclerosis are also risk factors for malignancy, certain patient groups undergoing CMR are at potential risk for important extra-cardiac findings. This chapter aims to provide a systematic overview of the type of extra-cardiac findings that may be detected on CMR, subdivided by anatomical location. Focus is placed on normal variant anatomy that may be confused for pathology, common extra-cardiac findings, and important imaging signs that help distinguish important pathology from benign entities. A framework to the approach and potential further diagnostic workup of incidental extra-cardiac findings discovered at the time of CMR is provided.