Spiral CT in acute non-cardiac chest pain

Oliver, Thomas; Murchison, JT; Reid, J H

doi:10.1016/s0009-9260(99)91238-2

Cited by 18 publications

(13 citation statements)

References 18 publications

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“…4 The technical leap with MD-CT was the creation of a cone-shaped x-ray beam generating image data over a volume, rather than a fan-shaped beam acquiring 1 axial section per rotation, 5,6 being displayed as 3D images along the centerline of flow (useful for evaluating vascular disease morphology and planning endovascular procedures). 7,8 The ability to view vessels in multiple projections and orientations helps evaluating the complex 3D anatomy of the aorta accentuated by tortuosity, dilation, or spiraling dissection ( Figure 1).…”

Section: Ct Angiography Of the Thoracic Aortamentioning

confidence: 99%

Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease

Nienaber

Kische

Skriabina

et al. 2009

Circ: Cardiovascular Imaging

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Section: Ct Angiography Of the Thoracic Aortamentioning

confidence: 99%

Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease

Nienaber

Kische

Skriabina

et al. 2009

Circ: Cardiovascular Imaging

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“…Like conventional angiography, CTA requires administration of nephrotoxic contrast. It frequently cannot visualize the entry and exit sites (intimal flaps) of a dissection and provides limited information about the coronary arteries and no information about the competency of the aortic valve 48, 49. Thus, if aortic dissection is identified by CTA, a second study may be needed to provide further diagnostic information and to guide surgical intervention (Figures 3 and 4).…”

Section: Confirmatory Imaging Studiesmentioning

confidence: 99%

Acute aortic dissection

Siegal

2006

Journal of Hospital Medicine

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Acute aortic dissection is an uncommon but lethal cause of acute chest, back, and abdominal pain. Establishing a timely diagnosis is paramount, as mortality from acute aortic dissection rises by the hour. Physical findings are protean and may include acute aortic valve insufficiency, peripheral pulse deficits, a variety of neurologic deficits, or end-organ ischemia. The keys to establishing a timely diagnosis are maintaining a high index of suspicion and quickly obtaining a diagnostic study. CT angiography, magnetic resonance imaging, transesophageal echocardiography, and, to a lesser extent, aortography are all highly accurate imaging modalities. The choice of study should be driven by the clinical stability of the patient, the information required and the resources available at presentation. KEYWORDS: aortic diseases, chest pain, hypertensive emergency, shock, Marfan syndrome, adrenergic beta-antagonists, vascular surgery, thoracic surgery A ortic dissection is an uncommon but highly lethal disease with an incidence of approximately 2,000 cases per year in the United States. 1 It is often mistaken for less serious pathology. In one series, aortic dissection was missed in 38% of patients at presentation, with 28% of patients first diagnosed at autopsy. 2 Early recognition and management are crucial. If untreated, the mortality rate for acute aortic dissection increases by approximately 1% per hour over the first 48 hours and may reach 70% at 1 week. As many as 90% of untreated patients who suffer aortic dissection die within 3 months of presentation. 3,4 Generally, cardiothoracic surgeons or cardiologists experienced with managing aortic dissection should direct patient evaluation and treatment. Hospitalists, however, are increasingly assuming responsibility for the initial triage and management of patients with acute chest pain syndromes and therefore must be able to rapidly identify aortic dissection, initiate supportive therapy, and refer patients to appropriate specialty care. PATHOPHYSIOLOGYAortic dissection occurs when layers of the aortic wall separate because of infiltration of high-pressure arterial blood. The proximate causes are elevated shear stress across the aortic lumen in the setting of a concomitant defect in the aortic media. Shear stress is caused by the rapid increase in luminal pressure per unit of time (dP/dt) that results from cardiac systole. As the aorta C O R E C O M P E T E N C Y R E V I E W

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“…4) [5,9]. Moreover, acute hematomas, either in the aortic wall or leaking into the mediastinum, are best seen before contrast due to their high density as compared with flowing blood or mural thrombus.…”

Section: Diagnostic Imaging In Noncardiac Acute Chest Painmentioning

confidence: 99%

“…Intimal tears are most commonly located a few centimeters above the aortic valve, along the right anterolateral wall of the ascending aorta, where hydrodynamic forces are greatest, or in the proximal segment of the descending aorta just beyond the insertion of the ligamentum arteriosum [5,14,15]. Many patients with classic aortic dissection also have a re-entry tear somewhere along the aorta or several communications between the true and false lumens.…”

Section: Aortic Dissectionmentioning

confidence: 99%

“…Pain was referred to anterior chest in 46 cases, back in 7, and to other sites in the remaining 13 patients. In a series of 70 patients with noncardiac chest pain undergoing spiral CT scan of the chest, Oliver et al [5] found aortic diseases as the origin of pain in 25 cases, pulmonary embolism in 4 patients, pericarditis in 4, and perforated duodenal ulcer in 1 patient; other causes of thoracic pain were present in 8 patients. Chest pain has also been described in patients with sickle cell disease and acute chest syndrome [6].…”

Section: Introductionmentioning

confidence: 99%

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Non-traumatic thoracic emergencies: acute chest pain: diagnostic strategies

et al. 2002

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Acute chest pain may represent the initial and/or accompanying symptom in a variety of disease processes that may occur in the cardiovascular system, respiratory system, gastrointestinal tract, or musculoskeletal system. Although clinical history, risk factors, and physical examination are important factors in establishing the etiology of symptoms in patients presenting with acute chest pain, imaging modalities are frequently utilized. Noncardiac causes of acute chest pain are reviewed in this paper with special reference to the most recently published literature and emphasis on acute aortic diseases. Imaging modalities with indication of appropriateness, optimal technique and practical keys for interpretation are discussed.

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Spiral CT in acute non-cardiac chest pain

Cited by 18 publications

References 18 publications

Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease

Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease

Acute aortic dissection

Non-traumatic thoracic emergencies: acute chest pain: diagnostic strategies

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