Things We Do for No Reason™: Overlooking incidental coronary artery calcification (iCAC)

A 58-year-old man with no significant medical history or prescribed medications, including coronary artery disease, presented to the emergency department with hypoxemia due to COVID-19. A non-contrast chest computed tomography (CT) ordered to evaluate for the cause of the patient's hypoxemia revealed mild ground-glass opacities and moderate incidental coronary artery calcium (iCAC), noted in the body of the report. The CT report impression only reads "Peripheral ground glass opacities in keeping with COVID-19 infection." The hospitalist, unsure of what do for moderate iCAC, discharged the patient to follow-up with his primary care provider without addressing it. Eighteen months later, the patient returned to the emergency department with an acute myocardial infarction.