Tyler A. Jacobson, MD, MBA, MPH; Wilson Blomberg, MD; Charles Haynes, MD; Joshua S. Engel, MD, MBA; Katherine Sherman, MS; Hannah Lee, MD; Michael Markl, PhD; Bradley D. Allen, MD, MSc; Matthew J. Scheidt, MD, FSIR; Jeff Whittle, MD, MPH
WMJ. 2026;125(4):509-512. Published November 1, 2026.
ABSTRACT
Background: The prevalence and incidental detection rates of thoracic aortic dilation (TAD) and thoracic aortic aneurysm (TAA) in computed tomography (CT)-based screening programs (eg, low-dose CT for lung cancer screening) are poorly characterized but could inform opportunistic screening strategies.
Methods: In this single-center retrospective cohort analysis, 9409 consecutive chest CT studies for 6795 unique patients at the Milwaukee Veterans Affairs Medical Center in Milwaukee, Wisconsin, were evaluated between January 2023 and January 2025. Radiology reports were reviewed manually. Incidental cases were defined as findings not previously documented in clinical notes or prior imaging. Point prevalence and incidental rates were calculated.
Results: The overall prevalence of TAD and TAA across CT cohorts was 6.1% (95% CI, 5.5%–6.6%) and 1.2% (95% CI, 0.95%–1.5%), respectively. The prevalence of TAD was 8.1% for low-dose CT (95% CI, 7.1%–9.1%), 8.3% for CT without contrast (95% CI, 6.5%–10.1%), and 3.2% for CT with contrast (95% CI, 2.6%–3.9%). The incidental detection rate of TAD was higher for low-dose CT (3.7%) than for CT without contrast (1.9%) and CT with contrast (1.2%).
Conclusions: Thoracic aortic dilation and thoracic aortic aneurysm are common among veterans undergoing clinically indicated chest CT imaging. Integrating opportunistic aortic assessment into existing CT screening programs deserves prospective evaluation to determine its clinical relevance and impact on downstream management.