Objective: To determine the prevalence and clinical significance of normal, variant, and anomalous branching patterns of the aortic arch and the central veins on computed tomographic (CT) angiography in adults.Methods: We retrospectively reviewed 1000 consecutive CT angiograms of the chest in 658 women and 342 men with a median age of 53 years.Results: A total of 65.9% of patients had both normal aortic arch branching patterns and normal venous anatomy. Variants in the aortic arch branching pattern were present in 32.4% and anomalies in 1.5%. Venous anomalies were present in 0.7%. Review of CT reports showed that cardiothoracic radiologists correctly reported the anomaly more frequently than other radiologists (94% vs 20%, P = 0.003).Conclusions: Whereas anomalies of the central thoracic vasculature are uncommon, variants in the aortic arch branching pattern are common. An appreciation of the appearance of these entities on CT angiography allows for precise reporting and is useful in preprocedure planning.

We propose a methodical diagnostic approach to determining the visceroatrial situs and cardiac configuration that predicts the probability and types of associated congenital heart disease.

A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.