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Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain.

Yoo SM, Rho JY, Lee HY, Song IS, Moon JY, White CS - Korean Circ J (2010)

Bottom Line: This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO).This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination.A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, CHA Medical University Hospital, Seongnam, Korea.

ABSTRACT
This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac CTA (i.e., dedicated coronary CTA versus TRO) to triage patients with nonspecific acute chest pain. This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination. A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

No MeSH data available.


Related in: MedlinePlus

Diagnostic delay in a 66-year-old female patient with Stanford type B dissection. This patient had a history of coronary stent insertion 2 years ago. The patient presented with acute chest pain to the emergency department. Emergent coronary angiography showed no significant stenosis in the coronary arteries. A Stanford type B aortic dissection (arrowheads) is noted on a trans-axial CT image at the level of aortic arch obtained 24 hours after coronary angiography.
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Figure 2: Diagnostic delay in a 66-year-old female patient with Stanford type B dissection. This patient had a history of coronary stent insertion 2 years ago. The patient presented with acute chest pain to the emergency department. Emergent coronary angiography showed no significant stenosis in the coronary arteries. A Stanford type B aortic dissection (arrowheads) is noted on a trans-axial CT image at the level of aortic arch obtained 24 hours after coronary angiography.

Mentions: The diagnostic delay of AAS is also a serious problem worldwide. According to studies, the annual incidence of ACS, PE, and AAS is 440, 69, and 3 per 100,000 individuals, respectively.12)13) As AAS is much less frequent compared with ACS and there is substantial overlap in clinical symptoms and signs between ACS and AAS, ED physicians tend to mistake AAS for ACS, and the reverse also occurs. One study reported that up to 39% of aortic dissections have a diagnostic delay of at least 24 hours (Fig. 2).14) Because the highest mortality of AAS occurs within the first 48 hours after onset of symptoms,15) there has been great interest in developing new approaches to reduce diagnostic delay or missed diagnosis. PE also has a nonspecific clinical presentation, rendering its immediate diagnosis difficult (Fig. 3).


Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain.

Yoo SM, Rho JY, Lee HY, Song IS, Moon JY, White CS - Korean Circ J (2010)

Diagnostic delay in a 66-year-old female patient with Stanford type B dissection. This patient had a history of coronary stent insertion 2 years ago. The patient presented with acute chest pain to the emergency department. Emergent coronary angiography showed no significant stenosis in the coronary arteries. A Stanford type B aortic dissection (arrowheads) is noted on a trans-axial CT image at the level of aortic arch obtained 24 hours after coronary angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008823&req=5

Figure 2: Diagnostic delay in a 66-year-old female patient with Stanford type B dissection. This patient had a history of coronary stent insertion 2 years ago. The patient presented with acute chest pain to the emergency department. Emergent coronary angiography showed no significant stenosis in the coronary arteries. A Stanford type B aortic dissection (arrowheads) is noted on a trans-axial CT image at the level of aortic arch obtained 24 hours after coronary angiography.
Mentions: The diagnostic delay of AAS is also a serious problem worldwide. According to studies, the annual incidence of ACS, PE, and AAS is 440, 69, and 3 per 100,000 individuals, respectively.12)13) As AAS is much less frequent compared with ACS and there is substantial overlap in clinical symptoms and signs between ACS and AAS, ED physicians tend to mistake AAS for ACS, and the reverse also occurs. One study reported that up to 39% of aortic dissections have a diagnostic delay of at least 24 hours (Fig. 2).14) Because the highest mortality of AAS occurs within the first 48 hours after onset of symptoms,15) there has been great interest in developing new approaches to reduce diagnostic delay or missed diagnosis. PE also has a nonspecific clinical presentation, rendering its immediate diagnosis difficult (Fig. 3).

Bottom Line: This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO).This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination.A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, CHA Medical University Hospital, Seongnam, Korea.

ABSTRACT
This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac CTA (i.e., dedicated coronary CTA versus TRO) to triage patients with nonspecific acute chest pain. This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination. A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

No MeSH data available.


Related in: MedlinePlus