Role of Triple Rule-Out Computed Tomography Angiography in the Management of Covid-19 Patients Presenting with Acute Chest Pain in Emergency Department

Abstract

Background: Acute chest pain is one of the most common presentations in the emergency department (ED). It could be difficult to reach the specific cause of the acute chest pain,yet rapid diagnosis could be lifesaving. After the COVID-19 pandemic, it has been more complex to reach a specific diagnosis, meanwhile there was increased need for rapid noninvasive testing. Coronary artery disease (CAD), pulmonary thromboembolism (PTE), and acute aortic syndromes (AAS) are the most serious causes of acute chest pain. Triple ruleout computed tomography angiography (TRO CTA) can examine the three vascular beds as well as lung parenchyma in a single study, so TRO CTA may play a crucial role in managing patients in this emergency condition. Aim of Study:To assess the clinical role of TRO CTA as a practical imaging tool in COVID-19 patients presented to the emergency department with acute chest pain.Patients and Methods: Retrospective study reviewed images of sixty-nine (69) patients who presented to ED with acute chest pain and diagnosed as COVID-19 positive patients, underwent TRO CTA, and were evaluated for the presence of any parenchymal or vascular cause of acute chest pain.Results: In the current study, the most detected cause of acute chest pain was parenchymal lung disease without significant vascular disease (50.7%), followed by pulmonary embolism (21.7%). The coronary causes of chest pain represent only 8.7%. We also found pericarditis in two cases (2.9%), hiatus hernia in two cases (2.9%), and aortic dissection in one case (1.4%). Conclusion:This study has shown that TRO CTA is a reliable imaging tool that can simultaneously evaluate the lung parenchyma and the three thoracic vascular beds and thus gives accurate results in COVID-19 patients presenting with acute chest pain.