Abstract

Ruling out of cardiovascular causes in acute unclear chest pain

posted by Thorsten R. C. Johnson, M.D. | Nov 21, 2007

Case history

A 65-year-old female presents with unclear chest pain and dyspnea. The symptoms are nonspecific. Initial troponin test and ECG are normal.

Question

Is there an acute cardiovascular condition requiring immediate intervention? Is there evidence of the cause of chest pain?

Diagnosis / Differential diagnosis

The most important and potentially lifethreatening causes of chest pain can be assessed in this single-breathhold scan. These include pulmonary embolism, coronary artery stenosis, aortic dissection, pulmonary edema, pneumonia or pneumothorax.

Findings

Pulmonary embolism can be ruled out reliably in CT angiography. The image quality of the coronary arteries is sufficient to extract the whole coronary artery tree automatically and assess them with curved multiplanar reconstructions. Aortic dissection or aneurysm can also be ruled out. The condition of the patient improves and she is discharged one day later without any specific intervention.

Comment

CT angiography can be used to rule out cardiovascular causes of chest pain and can thus provide a comprehensive and fast patient triage. This protocol can replace separate exams of the different vascular districts and thus help to reduce radiation exposure and the amount of required contrast material. The heart rate insensitivity of DSCT is very beneficial in these patients who frequently have high heart rates.

[1] The pulmonary arteries are well opacified and show no evidence of emboli.	[2] The aorta is not enlarged. There is no dissection membrane.
[3] The coronary arteries can be segmented automatically. There is no evidence of a stenosis or an occlusion.	[4] The dynamic reconstruction shows a normal valve morphology and motion as well as no wall motion abnormalities.