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Spiral CT in acute non-cardiac chest pain
T B Oliver1, J T Murchison, J H Reid
1Department of Clinical Imaging, Royal Infirmary of Edinburgh, UK.
Insights
Spiral CT is a reliable tool for diagnosing aortic dissection and other cardiovascular diseases presenting as chest pain. This study found that while aortic dissection is common, many other serious conditions also cause these symptoms.
Area of Science:
- Cardiovascular Imaging
- Thoracic Radiology
- Emergency Medicine
Background:
- Acute chest pain often prompts imaging for aortic dissection.
- Other cardiovascular diseases can mimic aortic dissection symptoms.
- Spiral CT is a key diagnostic modality in these cases.
Purpose of the Study:
- To evaluate the effectiveness of spiral CT in diagnosing suspected aortic dissection.
- To identify and quantify other cardiovascular disorders that simulate aortic dissection.
Main Methods:
- A 26-month retrospective review of CT scans for suspected aortic dissection.
- Analysis of CT findings correlated with clinical, surgical, and post-mortem data.
- Evaluation of diagnostic patterns and associated pathologies.
Main Results:
- 76 CT scans were reviewed in 70 patients; 66% showed abnormal findings.
- Common pathologies included thoracic aortic aneurysm (16), aortic dissection (14), and pericardial disease (12).
- Most patients presented with life-threatening conditions, and CT identified causes for pulse deficits in non-dissection cases.
Conclusions:
- Sudden chest pain indicates various acute cardiovascular disorders, often life-threatening.
- While aortic dissection is frequent, it's not the sole diagnosis.
- Spiral CT is accurate for diagnosing these conditions when performed meticulously.
Aim:
Spiral CT in acute non-cardiac chest pain is usually requested to diagnose aortic dissection but a spectrum of other cardiovascular diseases may simulate this. The purpose of this study was to assess the impact of spiral computed tomography (CT) in patients with suspected aortic dissection and to determine the nature and frequency of other disorders simulating it.
Methods:
Over a 26-month period, all patients undergoing CT for suspected acute aortic dissection were recruited. CT was performed using a standard protocol. The CT examinations and reports were reviewed along with other relevant imaging, clinical data, surgical findings and post-mortem results. The pattern of diagnoses and their associations were evaluated.
Results:
Seventy-six CT examinations were performed on 70 patients of whom 47 were male. The age of the patients ranged from 24 to 84. Seven patients had previously undergone cardiothoracic surgery. Twenty-four patients had normal CT findings; 46 patients (66%) had abnormal findings. Seventy-three significant pathologies were identified including thoracic aortic aneurysm (16 cases), aortic dissection (14 cases), acute intramural aortic haematoma (nine cases), aortic rupture (eight cases), atherosclerosis (four cases) and penetrating atheromatous ulcer (two cases), pulmonary embolus (four cases), pericardial disease (12 cases) and complications following surgery (three cases). The majority of patients had a life-threatening disease. Five patients without dissection had CT findings that explained clinical pulse deficits.
Conclusion:
Sudden onset non-cardiac, non-pleuritic chest pain is common to several acute cardiovascular disorders. Patients have a high incidence of life-threatening disease. Of this group, classic aortic dissection is the most common diagnosis but comprises a minority of cases. Spiral CT is a reliable diagnostic test but requires conscientious technique for optimum sensitivity and accuracy. Most patients will have abnormal CT findings.