The role of multi slice computed tomography in the evaluation of acute non-cardiac chest pain

Abstract

Introduction: Differential diagnosis of acute chest pain encompasses a broad spectrum of illnesses which are most likely followed by benign outcomes (pneumonia, pneumothorax, pleurisy, pericardial effusion, hiatus hernia), but also illnesses of lethal outcomes (pulmonary embolism, myocardial infarction, aortic dissection,thoracic aortic aneurysms, thoracic aortic aneurysm rupture, etc). Illnesses associated with benign and lethal outcomes may present very similar if not the same symptoms, resulting in a diffi cult establishment of accurate diagnosis.
Methods: During the period of one year, 123 patients presented with non-cardiac acute chest pain were referred for the multi slice computed tomography (MSCT) examination. Scanning of thorax was conducted
in two series: unenhanced and contrast-enhanced, using a window for pulmonary parenchyma and mediastinum.
Results: From a total number of patients 21.1% had normal results while the other 79.9% had pathological results. Out of the total number of patients with pathological result MSCT established potentially lethal outcome for 35.0%, out of which 83.7% was contributed to vascular territory of pulmonary artery, while 16.3% was contributed to aorta.
Conclusion: MSCT scanning, owe to its ability of simultaneous analysis of vascular and non-vascular thoracic structures, represents a very effi cient and reliable method for establishing accurate diagnosis and appropriate
triage of patients with acute chest pain. Accurate and effi cient diagnosis enables benefi cial outcome for the patient in this group of illness. MSCT enables the differentiation of etiological factors, which present as acute onset of non-cardiac chest pain.