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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

A case of negative coronary angiography and dedicated aortic CT angiography in a 42-year-old male patient with nonspecific acute chest pain. The patient presented with severe acute chest pain in both the anterior chest and back. Emergent coronary angiography was negative. Dedicated aortic CT angiography performed on the next day was also negative. The cause of acute chest pain in the patient was determined to be esophageal spasm.
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Figure 4: A case of negative coronary angiography and dedicated aortic CT angiography in a 42-year-old male patient with nonspecific acute chest pain. The patient presented with severe acute chest pain in both the anterior chest and back. Emergent coronary angiography was negative. Dedicated aortic CT angiography performed on the next day was also negative. The cause of acute chest pain in the patient was determined to be esophageal spasm.

Mentions: When performing a diagnostic work up in patients with nonspecific acute chest pain, we have encountered occasions in which serial coronary angiography and chest CT are negative (Fig. 4). The final diagnosis in these cases may be esophageal, musculo-skeletal, or cryptogenic in origin. Such patients are the best candidates for TRO studies. Rogg et al.16) reported performing multiple diagnostic examinations (e.g., coronary angiography and dedicated PE CTA) to exclude at least two of ACS, PE, or AAS in 139 cases (22%) among 626 cases presenting with acute chest pain. The specific multiple examinations for combinations of ACS and PE, ACS and AAS, and ACS, PE, and AAS were performed in 121 (19%), 14 (2%), and 4 cases (0.6%), respectively.16)


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)

A case of negative coronary angiography and dedicated aortic CT angiography in a 42-year-old male patient with nonspecific acute chest pain. The patient presented with severe acute chest pain in both the anterior chest and back. Emergent coronary angiography was negative. Dedicated aortic CT angiography performed on the next day was also negative. The cause of acute chest pain in the patient was determined to be esophageal spasm.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: A case of negative coronary angiography and dedicated aortic CT angiography in a 42-year-old male patient with nonspecific acute chest pain. The patient presented with severe acute chest pain in both the anterior chest and back. Emergent coronary angiography was negative. Dedicated aortic CT angiography performed on the next day was also negative. The cause of acute chest pain in the patient was determined to be esophageal spasm.
Mentions: When performing a diagnostic work up in patients with nonspecific acute chest pain, we have encountered occasions in which serial coronary angiography and chest CT are negative (Fig. 4). The final diagnosis in these cases may be esophageal, musculo-skeletal, or cryptogenic in origin. Such patients are the best candidates for TRO studies. Rogg et al.16) reported performing multiple diagnostic examinations (e.g., coronary angiography and dedicated PE CTA) to exclude at least two of ACS, PE, or AAS in 139 cases (22%) among 626 cases presenting with acute chest pain. The specific multiple examinations for combinations of ACS and PE, ACS and AAS, and ACS, PE, and AAS were performed in 121 (19%), 14 (2%), and 4 cases (0.6%), respectively.16)

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