HIV-infected persons are at higher risk for cardiovascular disease and may undergo computed tomographic (CT) scans for early detection. Incidental findings on cardiac CT imaging are important components of the benefits and costs of testing. We determined the prevalence and factors associated with incidental findings on CT scans performed for screening for coronary artery calcium (CAC) among HIV-infected men. A clinically significant finding was defined as requiring further work-up or medical referral. A total of 215 HIV-infected men were evaluated with a median age of 43 years, 17% were current tobacco users, median CD4 count was 580 cells/ mm 3 , and 83% were receiving antiretroviral medications. Thirty-four percent had a positive CAC score of >0. An incidental finding was noted among 93 (43%) of participants, with 36 (17%) having at least 1 clinically significant finding. A total of 139 findings were noted, most commonly pulmonary nodules, followed by granulomas, scarring, and hilar adenopathy. The majority of incidental findings were stable on follow-up, and no malignancies were detected. Factors associated with having an incidental finding in the multivariate model included increasing age (OR 1.6 per 10 years, p<0.01), positive CAC score (OR 2.3, p<0.01), and current tobacco use (OR 2.5, p=0.02). In conclusion, incidental findings are common among HIV-infected persons undergoing screening CT imaging for CAC determination. Incidental findings were more common among older patients and those with detectable CAC.

Background Cardiovascular disease is an increasing concern among HIV‐infected persons and their providers. We determined if fatty liver disease is a marker for underlying coronary atherosclerosis among HIV‐infected persons. Methods We performed a cross‐sectional study in HIV‐infected adults to evaluate the prevalence of and factors, including fatty liver disease, associated with subclinical coronary atherosclerosis. All participants underwent computed tomography for determination of coronary artery calcium (CAC; positive defined as a score >0) and fatty liver disease (defined as a liver‐to‐spleen ratio <1.0). Factors associated with CAC were determined using multivariate logistic regression models. Results We included in the study 223 HIV‐infected adults with a median age of 43 years [interquartile range (IQR) 36–50 years]; 96% were male and 49% were Caucasian. The median CD4 count was 586 cells/μL and 83% were receiving antiretroviral medications. Seventy‐five (34%) had a positive CAC score and 29 (13%) subjects had fatty liver disease. Among those with CAC scores of 0, 1–100 and >100, the percentage with concurrent fatty liver disease was 8, 18 and 41%, respectively (P=0.001). In the multivariate model, CAC was associated with increasing age [odds ratio (OR) 4.3 per 10 years; P<0.01], hypertension (OR 2.6; P<0.01) and fatty liver disease (OR 3.8; P<0.01). Conclusions Coronary atherosclerosis as detected using CAC is prevalent among young HIV‐infected persons. The detection of fatty liver disease among HIV‐infected adults should prompt consideration of assessment for underlying cardiovascular disease and risk factor reduction.

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The practicing dermatologist uses many medical devices during his or her day-to-day practice. The authors present a broad overview of how such medical devices are reviewed for safety and reasonable assurance of effectiveness, and evaluated for classification prior to marketing in the United States by the Food and Drug Administration. The specific example of dermal fillers as a class III medical device is discussed together with its regulatory ramifications. This article is written by staff currently employed at the Center for Devices and Radiological Health and should provide information useful to the practicing dermatologist.

DESCRIPTIONA 75-year-old woman who had a bioprosthetic mitral valve replacement and complete left atrial appendage (LAA) ligation a year ago was found to be in atrial flutter at routine clinical follow-up. She was started on warfarin and brought back for a transoesophageal echocardiogram (TOE)-guided cardioversion. On the TOE, a left atrial thrombus overlying the ligated LAA was discovered (figure 1). The patient was asymptomatic, and since she had a CHADS score of 2, we continued her on warfarin indefinitely. She was set-up for a repeat TOE and cardioversion 1 month later. During this TOE, she demonstrated resolution of the thrombus (figure 2) and subsequent successful cardioversion. A couple of months later, she had a successful atrial flutter ablation procedure performed.The LAA is a common site for thrombus formation and thus the origin of many cardioembolic events. Ligation of the LAA during valvular surgery is often performed with the intent of minimising the risk of thrombus formation. However, patients remain at risk for thromboembolic events even after LAA ligation.1 Prior reports have documented thrombi formation after disruption of the suture line. 2 3 Here, we extend these findings and demonstrate that left atrial thrombus formation is still possible despite a complete and intact left atrial appendage ligation.