Mimics of acute coronary syndrome on MDCT
Mohammad Ali Husainy1, Deepa Gopalan, Mini Pakkal
1Department of Clinical Radiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. guchchan@gmail.com
Insights
This review highlights common and rare conditions that mimic acute coronary syndrome (ACS) on multi-detector computed tomography (MDCT). Awareness of these ACS mimics is crucial for accurate diagnosis and appropriate imaging protocols.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Acute coronary syndrome (ACS) is a spectrum of unstable coronary artery disease.
- Management often depends on electrocardiogram (ECG) findings.
- Non-ST elevation ACS patients increasingly undergo urgent coronary angiography.
Purpose of the Study:
- To identify and present true mimics of ACS on multi-detector computed tomography (MDCT).
- To emphasize the importance of recognizing these mimics for accurate diagnosis.
- To suggest a universal MDCT imaging protocol for suspected ACS.
Main Methods:
- Review of clinical practice cases presenting as ACS.
- Analysis of multi-detector computed tomography (MDCT) findings.
- Discussion of imaging techniques and protocols.
Main Results:
- A proportion of patients with normal coronary angiography have alternative diagnoses.
- MDCT can reveal various conditions mimicking ACS.
- Awareness of mimics allows for tailored imaging approaches.
Conclusions:
- Clinicians and radiologists must be aware of ACS mimics on MDCT.
- Appropriate imaging protocols can improve diagnostic accuracy.
- Recognizing non-cardiac causes presenting as ACS is vital for patient management.
Abstract:
Acute coronary syndrome (ACS) encompasses a spectrum of unstable coronary artery disease ranging from transmural myocardial infarction to unstable angina. The immediate management of these patients is dictated by the presence/absence of ST segment changes on electrocardiogram. More and more patients with non-ST elevation ACS are bypassing traditional diagnostic pathways to undergo urgent coronary catheter angiography. A proportion of these patients will have normal coronary angiography and an alternative diagnosis is often sought with multi-detector computed tomography (MDCT). It is vital that clinicians and radiologists are aware of the usual and unusual mimics of ACS so they can modify their imaging technique and protocol accordingly. In this review, we present some true mimics of ACS on MDCT, from our practice, and suggest an imaging protocol that can be utilised universally.
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