Incidental thoracic findings in CT-scans before Transcatheter Aortic Valve Implantation (TAVI)

Introduction:

Preoperative CT-scans for transcatheter aortic valve implantation (TAVI) provide also the possibility for the screening of thoracal malignancies in high-risk patients for cardio-pulmonary diseases.

Methods:

Radiological reports of contrast-enhanced CT-scans of 976 patients scheduled for TAVI were analysed retrospectively for pulmonary nodules, mediastinal lymphadenopathy and pleural effusions. The minimum follow-up period was 1 year after TAVI.

Results:

The mean age of all patients was 78.9 years and 51.9% (n = 507) were women. Approximately 53% (n = 519) of patients showed one of the determined findings. A pulmonary nodule ≥5 mm was diagnosed in 16.4% (n = 160) of patients. Four of them developed lung cancer and two nodules were identified as metastases during follow-up. In addition, 12% (n = 117) of patients had lymphadenopathy and 19,6% (n = 191) had pleural effusions. Whilst pulmonary nodules had no significant effect on the overall mortality of the patients, evidence of lymphadenopathy turned out to be a statistically significant factor regarding 4-year-survival (p = 0.001, Hazard-ratio 1.77).

Conclusions:

Even pulmonary nodules ≥5 mm can be a sign for potential malignancy, an effect on survival could not be found in this high risk group of patients, which might be caused by the increased age of the study sample. In contrast, mediastinal lymphadenopathy had a significant effect on survival and it needs to be proven if further diagnostics and therapy are able to raise the survival rate.