Spiral CT in acute non-cardiac chest pain

Aim: Spiral CT in acute non-cardiac chest pain is usually requested to diag nose 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 a cute aortic dissection were recruited. CT was performed using a standard pr otocol. The CT examinations and reports were reviewed along with other rele vant 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 n ormal CT findings; 46 patients (66%) had abnormal findings, Seventy-three s ignificant 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) an d penetrating atheromatous ulcer (two cases), pulmonary embolus (four cases ), pericardial disease (12 cases) and complications following surgery (thre e cases). The majority of patients had a life-threatening disease. Five pat ients without dissection had CT findings that explained clinical pulse defi cits, 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 m ost common diagnosis but comprises a minority of cases. Spiral CT is a reli able diagnostic test but requires conscientious technique for optimum sensi tivity and accuracy. Most patients will have abnormal CT findings.