Cardiac Imaging Findings at Nongated Chest CT in the Emergency Department

The heart is included in all chest imaging and should be systematically evaluated in patients presenting to the emergency department, particularly if a noncardiac cause of the patient's symptoms is not identified. The authors review nontraumatic acute cardiac diseases and complications, describe the importance of evaluating the heart with emergency thoracic imaging, and identify acute nontraumatic cardiac abnormalities seen at chest CT in the emergency department. A systematic checklist and approach to evaluate the heart with emergency medical imaging is outlined for noncardiac radiologists to categorize diseases as coronary artery related or noncoronary artery related. Coronary artery-related diseases that can be identified with nondedicated nonelectrocardiographically gated chest CT performed in the emergency department include myocardial infarction, spontaneous coronary artery dissection, vasculitis, an anomalous origin of the coronary arteries, and coronary artery fistulas. Noncoronary artery-related diseases that can be identified at chest imaging performed in the emergency department include acute myocarditis, pericarditis, pericardial tamponade, endocarditis, thrombi, cardiac masses, and pericardial fat necrosis. Identification and communication of cardiac imaging findings in the emergency department should be guided by the patient's clinical presentation and the need for urgent treatment. ^©RSNA, 2025 Supplemental material is available for this article.