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Incidental Vascular Findings (ACR)
Guided management from the ACR Incidental Findings Committee II white paper on vascular findings (Khosa et al., JACR 2013). Pick the finding and answer the prompts; an optional paste box pre-selects what it can. Applies to incidental findings on abdominal/pelvic CT and MRI in asymptomatic patients.
Encodes the ACR Incidental Findings Committee II vascular white paper (Khosa et al., JACR 2013;10:789-794, including Table 1). For incidental findings in asymptomatic patients. Symptomatic or acute vascular conditions (dissection, intramural hematoma, ruptured or symptomatic aneurysm) are not incidental and need prompt clinical evaluation. Intervals also vary with comorbidities, growth rate and life expectancy. Recommendations, not standard of care.
Parses the finding (aorta, iliac, splenic, renal, hepatic/visceral, May-Thurner, nutcracker, thrombosis, ovarian) and a size to pre-select below — always review.
Reference — ACR Vascular white paper + AAA Table 1
Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings. J Am Coll Radiol 2013;10:789-794.
Table 1 — AAA / dilated aorta initial follow-up interval (by maximal diameter):
* Also consider surgical or endovascular referral. Rupture frequency rises as size exceeds 5 cm; elective repair is generally considered around 5.5 cm. (Table header reads “mm” in the original but values are in cm.)
Other thresholds encoded from the paper text: iliac aneurysm ≥ 2.5 cm (or ≥ 1.5× normal), follow at 6 mo then annually for 3.0–3.5 cm, treat/follow closely > 3.5 cm; splenic artery aneurysm yearly < 2 cm, consider treatment ≥ 2 cm; RAA follow 1.0–1.5 cm every 1–2 y, repair > 1.5–2.0 cm (or ≥ 1 cm with uncontrolled hypertension); other visceral aneurysm treat > 2 cm (pancreaticoduodenal often treated regardless of size).
Table 1 — AAA / dilated aorta initial follow-up interval (by maximal diameter):
| Diameter | Interval |
|---|---|
| < 2.5 cm | Follow-up generally unnecessary |
| 2.5–2.9 cm | 5 years |
| 3.0–3.4 cm | 3 years |
| 3.5–3.9 cm | 2 years |
| 4.0–4.4 cm | 1 year |
| 4.5–4.9 cm | 6 months * |
| 5.0–5.5 cm | 3–6 months * |
Other thresholds encoded from the paper text: iliac aneurysm ≥ 2.5 cm (or ≥ 1.5× normal), follow at 6 mo then annually for 3.0–3.5 cm, treat/follow closely > 3.5 cm; splenic artery aneurysm yearly < 2 cm, consider treatment ≥ 2 cm; RAA follow 1.0–1.5 cm every 1–2 y, repair > 1.5–2.0 cm (or ≥ 1 cm with uncontrolled hypertension); other visceral aneurysm treat > 2 cm (pancreaticoduodenal often treated regardless of size).
