This chapter discusses the potential role of routine non-gated chest computed tomography (CT) in the diagnosis and management of coronary artery and other thoracic great vessel pathologies. We emphasize coronary artery, thoracic aorta, and breast artery calcifications; coronary artery anomalies of origin, course, and termination; aneurysms and fistulas; and thoracic aorta and pulmonary artery dilatation, including pulmonary hypertension. We also review cases of thoracic aortic dilatation, aneurysm/dissection, pulmonary embolism, and aortitis, which can sometimes be discovered incidentally on routine non-cardiovascular chest CT.