Unveiling incidental findings: A clinical review of a giant aneurysm detected by CBCT imaging

Abstract

Cone beam computed tomography (CBCT) is an advanced imaging modality that has transformed the field of dentistry with its high-resolution and three-dimensional (3D) imaging capabilities. It has proven to be an invaluable tool for diagnostic and treatment planning purposes, and the increased use of large CBCT imaging has led to a corresponding rise in unexpected incidental findings, especially in orthodontics and implant planning. These incidental findings may be clinically significant and indicate medical emergencies requiring immediate intervention or referral. This clinical review presents a case of a 64-year-old female who was referred for a CBCT examination to assess a radiopacity in the left maxillary sinus. Incidentally, the scan revealed a giant internal carotid artery (ICA) aneurysm in the right middle cranial fossa. Prompt recognition and proper management led to a successful intervention using endovascular surgical treatment, potentially averting a catastrophic rupture. This case demonstrates the critical role of CBCT imaging in identifying potentially life-threatening conditions beyond the primary area of interest. In our review, we underscore the ethical responsibilities of dental practitioners in managing incidental findings. Practitioners must ensure that CBCT scans in their entirety are fully assessed and interpreted, and must stay current with the guidelines for advanced imaging interpretation. Proper management entails the proper communication and documentation of incidental findings, and subsequent referral to the appropriate specialists. By fulfilling these responsibilities, dental professionals can continue to uphold the highest standards of patient care, reducing the risk of missed diagnoses and enhancing interdisciplinary collaboration for optimal patient outcomes.