E3305. Chest Pain Etiologies Beyond Aortic Dissection: Uncovering Diverse Diagnoses Through CTA Imaging
  1. Alice Kim; Temple University Hospital
  2. Star Chen; Temple University Hospital
  3. Maruti Kumaran; Temple University Hospital
Just as heart ischemia can present as jaw pain, chest pain is an ambiguous clinical presentation that includes a variety of causes. A broad differential needs to be considered and imaging utilized to aid in identifying life-threatening from less-urgent etiologies. Chest CTA imaging is widely utilized due to its ability to optimize imaging parameters, assess soft tissue structures, and evaluate crucial vessels. Given potential overlap in clinical presentation with other conditions, this exhibit highlights the importance of radiologic evaluation in the context of chest pain while focusing on identifying aortic dissection and other potential causes that may mimic its clinical presentation.

Educational Goals / Teaching Points
Acknowledging ambiguity in the clinical presentation of chest pain: when presented with a patient complaining of chest pain, a clinician immediately runs through a cardiac-based differential and workup. Its ambiguity, however, lies in its various causes in the setting of a complicated and interconnected system. Use of CT imaging in discerning life-threatening from less-urgent etiologies: CT parameters can be manipulated and optimized using factors such as time, contrast volume, and electrocardiac gating. This allows for the identification of areas of injury, such as dissection, or filling defects consistent with thrombus. It also allows for thin-sectional evaluation of other soft tissue structures that can be better delineated using IV contrast. Avoiding anchor bias: chest pain does not eliminate the possibility of an alternate organ etiology. For example, this study demonstrated that out of 310 studies, only 15 (5%) were positive for aortic dissection and 69 (22%) had other attributable intrathoracic and abdominopelvic findings. Importance of a comprehensive search pattern: study results support that aortic causes do not comprise the majority of those presenting with chest pain, and that other potential etiologies should be sought to improve patient treatment and management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Out of 310 studies, 15 (5%) were positive for aortic dissection and 69 (22%) had other attributable diagnoses. Other intrathoracic and abdominopelvic findings included rib fractures, coronary artery occlusion, small bowel obstruction, median arcuate ligament syndrome, herniated bowel, acute cholecystitis, pancreatitis, pyelonephritis, obstructive hydroureteronephrosis, and renal hemorrhage.

Timely diagnosis of life-threatening conditions, including aortic causes, is crucial in the setting of chest pain. However, this study reveals other potential pathologies to consider, which can often be well-elucidated in CTA studies. Automating a comprehensive search pattern helps avoid mistakes and ensures identification and recruitment of multidisciplinary teams for other treatable causes.