Radiological tests in investigations of atypical chest pain

Atypical chest pain (ACP) is a diagnostic challenge that often requires multiple laboratory and radiological investigations. While radiological procedures may not be the first line of investigation in most cases, they are invaluable when appropriately applied. Physicians need to have a good understanding of the capabilities and limitations of these constantly evolving imaging modalities.

This article provides an overview of radiological modalities as they relate to the investigation of ACP. The focus is on radiological procedures that general practitioners may come across when investigating their patients. A brief outline is provided of specialist radiological investigations. The nature of the procedures, their diagnostic yield and appropriateness are addressed. Nonradiological procedures such as coronary angiography, stress tests, ventilation/perfusion scan, resting myocardial perfusion scan, echocardiography and gastroscopies are not discussed.

While a thorough history and careful physical examination is paramount, diagnostic imaging is indispensable in patients presenting with ACP. Chest X-ray is almost universally obtained. Other modalities are of value only when appropriately applied.