Systematic evaluation of extracardiac findings on cardiac CT angiography in children with CHD: a large single-centre experience.

Abstract

Introduction: Cardiac CT angiography has seen a steady increase in use for the evaluation of CHD in children. While its primary role is to assess cardiovascular structures, CT angiography also captures extracardiac regions, often revealing previously unsuspected abnormalities. This study sought to determine the prevalence, classification, and clinical relevance of extracardiac abnormalities detected in paediatric patients undergoing CT angiography for CHD evaluation.

Materials and methods: A retrospective review was conducted on CT angiography examinations from 1336 patients, aged from newborn to 17 years, at a single tertiary care institution. Extracardiac findings within the thoracic and abdominal regions were systematically identified, categorised, and analysed statistically.

Results: Extracardiac abnormalities were common, predominantly affecting the respiratory system, including pneumonia (14.5%), atelectasis (13.3%), and pulmonary oedema (11.5%). Airway changes included bronchial malposition (23.3%) and peribronchial thickening (8.3%). Abdominal anomalies were also detected, the most common being hepatomegaly (13.1%), splenomegaly (6.9%), and horseshoe kidney (5.7%). Several of these findings were clinically important and had the potential to affect patient management.

Discussion: Extracardiac anomalies are a common finding in paediatric CT angiography performed for CHD evaluation and can have significant clinical consequences. Radiologists and clinicians should follow a systematic approach that evaluates both cardiovascular and extracardiac structures to improve diagnostic accuracy and optimise patient care. In addition to common thoracic and abdominal abnormalities, CT angiography enabled the identification of rare and complex extracardiac anatomical patterns, underscoring its value as a comprehensive imaging modality in paediatric CHD.