„Triple-rule-out“-Computertomographie in der Notaufnahme

Abstract

In the emergency department patients with chest pain play an important role because the underlying and concealed diseases can be life-threatening. The complaints are often nonspecific and patients also have different risk profiles. In patients in the emergency department with nonspecific chest pain a"1-stop strategy" for elucidation of the three main organs lung, hear and aorta with the 4 main differential diagnoses (aortic dissection, ruptured aortic aneurysm, pulmonary embolism and coronary heart disease) is desirable. Technical advances in computed tomography (CT) in recent years make this approach technically possible. In modern emergency departments CT equipment is becoming more and more common in order to rapidly examine trauma patients. A meaningful patient selection and preparation are, however, necessary to avoid unnecessary exposure of patients to contrast media and radiation. In this way it is possible to reduce the rate of overlooked diseases or false diagnoses.

The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

“…TRO-CT can accurately rule out ACS with excellent negative predictive values [ 4 ] in the majority of patients with acute chest pain and could identify those with significant coronary artery stenosis. Moreover, anatomic imaging of the whole chest with TRO-CT can also detect non-coronary causes of acute chest pain, helping emergency department physicians to rapidly direct patients to the most appropriate in- or out-patient treatment [ 5 ].…”