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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 3  |  Page : 962-965

Role of multi-detector computed tomography in diagnosis of non cardiac causes of acute chest pain


1 Department of Radiodiagnosis, Ministry of Health, Menoufia University, Menoufia, Egypt
2 Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission12-Nov-2018
Date of Decision06-Jan-2019
Date of Acceptance08-Jan-2019
Date of Web Publication30-Sep-2020

Correspondence Address:
Maha M. A. Mousa
El-Shohada, El-Menoufia Governorate, Egypt
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_364_18

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  Abstract 


Objective
The objective of this study was to evaluate the role of multidetector computed tomography (CT) in the diagnosis of noncardiac causes of chest pain.
Background
Noncardiac chest pain is common in the general population and impacts significantly the quality of life, yet only a minority seeks medical attention.
Patients and methods
This study was carried out as a cross-sectional study and included 55 patients who presented with acute or chronic chest pain and some of them had with chest pain one or more of the following symptoms and signs: cough, fever, dyspnea, hemoptysis, and bulging mass. They were recruited from the Radiology Department of Menoufia University Hospital and Al-Azhar University Hospital within the period from February 2016 to December 2017; their ages ranged between 1 and 75 years. An informed consent was obtained from all participants in this research after full explanation of the benefits and risks of the CT examination. All patients were clinically evaluated and had routine assessment and underwent multidetector CT chest examination.
Results
According to chest CT diagnosis of the studied population, infection (30.9%) and pulmonary embolism (12.7%) were the most common diagnosis. Regarding the ability of CT to diagnose bronchogenic carcinoma, the sensitivity and specificity were found to be 83 and 50%, respectively, and for pulmonary embolism the sensitivity and specificity were found to be 100 and 100%, respectively.
Conclusion
Chest pain is one of the most common presenting symptoms for patients coming to the emergency department. Contrast-enhanced multidetector CT has replaced previous invasive diagnostic procedures when there is the clinical suspicion of pulmonary embolism or acute aortic syndrome.

Keywords: chest pain, computed tomography, embolism


How to cite this article:
Mousa MM, Mohammed HH, Hemeda YH. Role of multi-detector computed tomography in diagnosis of non cardiac causes of acute chest pain. Menoufia Med J 2020;33:962-5

How to cite this URL:
Mousa MM, Mohammed HH, Hemeda YH. Role of multi-detector computed tomography in diagnosis of non cardiac causes of acute chest pain. Menoufia Med J [serial online] 2020 [cited 2020 Oct 20];33:962-5. Available from: http://www.mmj.eg.net/text.asp?2020/33/3/962/296671




  Introduction Top


Chest ache is one of the most common imparting signs for patients coming to the emergency branch [1].

Noncardiac chest ache is not unusual in the standard populace and its impacts are more apparently at the first-class of existence, yet at best only a minority seeks medical attention [2].

Pericardium is frequently involved in direct cardiac invasion by the adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life-threatening presentation in such cases. Myocardial compression and invasion by adjacent lung mass may result in myocardial ischemia and may present with retrosternal, oppressive chest pain which clinically may simulate with acute myocardial infarction [3].

Multidetector computed tomography (CT) has awesome accuracy in demonstrating noncardiac reasons of chest ache, such as pneumothorax, pneumonia, malignancies, pulmonary airspace abnormalities, and interstitial lung disorder. Pericardial effusions, thickening, and calcifications are seen a long way extra with ease than with radiography by the author himself. In the placing of undifferentiated chest ache, CT angiography with its high sensitivity and specificity can be taken into consideration the modality of choice to diagnose suspected pulmonary embolism (PE) or aortic pathology along with aortic dissection or aneurysm [4].

Although acute chest pain is frequent, the workup of these sufferers stays a primary medical assignment for the subsequent two motives; some of the pathologies important to acute chest pain are doubtlessly existence threatening and require instant prognosis and remedy consisting of acute coronary syndrome, acute aortic syndrome, pulmonary artery embolism, pericardial tamponade, tension pneumothorax, and esophageal rupture. An excellent variety of various thoracic, stomach, musculoskeletal, and even psychiatric disorders can manifest as acute chest pain, which makes the differential analysis difficult. As the spectrum of acute chest pain causes is vast and now not all lifestyle-threatening reasons are of cardiac origin, we are concerned with noncardiac vascular and pulmonary causes [5].

So, the primary desires of the diagnostic pathway in acute chest pain sufferers beneath emergency situations are two-fold, that is, figuring out probably acute existence-threatening disease and clarify the broad spectra of differential diagnosis to direct the patient's manner on the ideal track immediately [6].

Multidetector CT has wonderful accuracy in demonstrating noncardiac reasons of chest pain, which include pneumothorax, pneumonia, malignancies, pulmonary airspace abnormalities, and interstitial lung disorder. Pericardial effusions, thickening, and calcifications are seen far greater effortlessly than with radiography alone. Inside the placing of undifferentiated chest pain, CT angiography with its high sensitivity and specificity can be taken into consideration the modality of desire to diagnose suspected PE or aortic pathology together with aortic dissection or aneurysm [7].

This study aimed to evaluate the role of multidetector CT in the diagnosis of noncardiac causes of chest pain.


  Patients and Methods Top


Ethical consideration approval became acquired by means of the Health Facility Ethics Committee and written knowledgeable consent from affected persons with an explanation regarding the reason, techniques, results, and full explanation of the benefits and risks of the CT examination have been taken from all the enrolled patients. This study was carried out as a cross-sectional study and included 55 patients who presented with acute or chronic chest pain and some of them had with chest pain one or more of the following symptoms and signs: cough, fever, dyspnea, hemoptysis, and bulging mass. They were recruited from the Radiology Department of Menoufia University Hospital and Al-Azhar University Hospital within the period from February 2016 to December 2017. Their ages ranged between 1 and 75 years) (mean age: 38 years). All patients were clinically evaluated and had routine assessment and underwent multidetector CT chest examination.

The inclusion criteria were patients presented with acute or chronic chest pain. Exclusion criteria were refusal to participate in this research.

All included patients underwent detailed history taking, they were clinically evaluated, had habitual laboratory investigations, and multidetector CT according to the clinical state of patients. Ten patients underwent CT pulmonary angiography to detect PE, whereas 14 patients underwent CT with contrast to diagnose: suspected chest tumor (lymphoma, bronchogenic tumors), lung metastasis in patients with known primary tumor, and lung abscess.

All data were collected, tabulated, and statistically analyzed using SPSS 19.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Data were expressed as mean ± SD. Student's t-test was used to assess the difference between the studied parameters in the two groups. The frequencies were expressed in percentage. χ2 was used to assess the difference between the studied frequencies in the two groups. Probability (P) was considered significant if less than 0.05 and highly significant if less than 0.001.


  Results Top


In our study, there were 55 patients: 38 (69.1%) men and 17 (30.9%) women. Forty-two (76.4%) patients were complaining of other symptoms associated with chest pain such as cough, fever, hemoptysis, dyspnea, back pain and bulging mass; 13 (23.6%) patients were complaining of chest pain only without other associated symptoms. Cough was the most common associated symptom in the study group representing 27.3%.

According to chest CT diagnosis of the studied population, lung infection [Figure 1] and [Figure 2], PE [Figure 3], and bronchogenic carcinoma [Figure 4] were the most common diagnosis as they represented 30.9, 12.7, and 10.9% of the studied patients regarding CT diagnosis [Table 1].
Figure 1: Multidetector computed tomography of the chest without contrast revealed lung abscess.

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Figure 2: Multidetector computed tomography of the chest without contrast revealed pneumonia.

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Figure 3: Computed tomography pulmonary angiography revealed (pulmonary embolism) thrombus in main right upper and lower lobe segmental branch.

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Figure 4: Multidetector computed tomography of the chest without contrast revealed (bronchogenic carcinoma) right lower lobe lesion causing narrowing right lower lobe bronchus and distal consolidation patch. Enlarged paratracheal and subcarinal lymph nodes, small pulmonary nodules.

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Table 1: Distribution of the studied patients regarding computed tomography diagnosis

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Regarding ability of CT to diagnose bronchogenic carcinoma the sensitivity and specificity were 83 and 50%, respectively, and for PE the sensitivity and specificity were 100 and 100%, respectively.


  Discussion Top


In this research, most of the included patients were men. Sayed et al. [5] who studied 89 patients found that 59 (66.2%) and 30 (33.7%) were men and women, respectively. Kumaresh et al. [7] stated that men were more likely to be diagnosed with chest pain than women. Dumville et al. [8] found that women were approximately twice as likely as men to continue to suffer from ongoing noncardiac chest pain.

The majority of chest pain causes in this study were due to infection and PE. In the study of Sayed et al. [5] who studied 89 patients the majority of chest pain causes was due to pulmonary etiologies detected in 71 (80%) of 89 cases, whereas vascular causes were detected in 18 (20%) only.

In this study, the sensitivity of CT to diagnose bronchogenic carcinoma was 83.0% and the specificity was 50.0%. Hoque et al. [9] found that the sensitivity of CT to diagnose lung tumors was 97.4%, specificity 76.9%, positive predictive value 92.5%, and the negative predictive value was 90.9% with an accuracy of 92.2%.

In this study, there were six cases of bronchogenic carcinoma were detected by CT which confirmed by histopathological findings in five of them. Hoque et al. [9] stated that out of all patients, 37 cases were diagnosed as bronchogenic carcinoma by CT and confirmed by cytopathological evaluation. They found that CT was a moderately accurate modality in predicting the presence of airway abnormalities with sensitivity from 63 to 85% and specificity from 61 to 77%.

As stated by Finkelstein et al. [10], the overall sensitivity and specificity of CT scan in the detection of tracheobronchial malignancies were 59 and 85%.

Among life-threatening causes, PE was the most common cause encountered throughout the period of our study and was detected in seven (12.5%) of our studied cases. CT pulmonary angiography has become the standard of care for the evaluation of patients with suspected PE in most institutions [11].

In this study, we found that the sensitivity and specificity of CT in the diagnosis of PE were 100 and 100%, respectively. Nilsson et al. [12] found that s-CTPA had 91% sensitivity, 96% specificity, 94% positive predictive value (PPV) and 95% negative predictive value (NPV).


  Conclusion Top


Chest pain is one of the most common presenting symptoms for patients presenting to the emergency department. Contrast-enhanced multidetector CT has replaced previous invasive diagnostic procedures when there is clinical suspicion of PE or acute aortic syndrome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wong BLB. Chest pain – a guide to our daily clinical practice. Med Bull 2009; 14:38–46.  Back to cited text no. 1
    
2.
Eslick JD, Jones MP, Talley NJ. Non-cardiac chest pain: prevalence, risk factors, impact and consulting – a population-based study. Aliment Pharmacol Ther 2003; 17:1115–1124.  Back to cited text no. 2
    
3.
Das A, Das SK, Pandit S, Karmakar RN. Bronchogenic carcinoma with cardiac invasion simulating acute myocardial infarction. Case Rep Oncol Med 2016; 2016:7813509.  Back to cited text no. 3
    
4.
Nikolaou K, Thieme S, Sommer W, Johnson T, Reiser MF. Diagnosing pulmonary embolism, new computed tomography applications. J Thorac Imaging 2010; 25:151–160.  Back to cited text no. 4
    
5.
Sayed R, Mansour H, Khaleel M, Abo Gamra SH, Nasr MA. Role of multidetector CT in evaluation of acute chest pain: non-cardiac vascular and pulmonary causes. Egypt J Hosp Med 2013; 51:385–394.  Back to cited text no. 5
    
6.
Hoffmann U, Venkatesh V, White RD, Woodard PK, Carr JJ, Dorbala S, et al. ACR Appropriateness Criteria: acute nonspecific chest pain-low probability of coronary artery disease. J Am Coll Radiol 2012; 10:745–750.  Back to cited text no. 6
    
7.
Kumaresh A, Kumar M, Dev B, Gorantla R, Sai V, Thanasekaraan V. Back to basics – 'Must know' classical signs in thoracic radiology. Clin Imaging Sci 2015; 5: 43.  Back to cited text no. 7
    
8.
Dumville JC, MacPherson H, Griffith K. Non-cardiac chest pain: a retrospective cohort study of patients who attended a Rapid Access Chest Pain Clinic. Fam Pract 2007; 24:152–157.  Back to cited text no. 8
    
9.
Hoque MS, Hashem MA, Hasan S, Siddique AB, Hossain A, Mahbub M, et al. Role of CT scan in the evaluation of lung tumor with cytopathilogical correlation. Faridpur Med Coll J 2014; 9:37–41.  Back to cited text no. 9
    
10.
Finkelstein SE, Schrump DS, Nguyen DM, Hewitt SM, Kunst TF, Summers RM. Comparative evaluation of super high-resolution CT scan and virtual bronchoscopy for the detection of tracheobronchial malignancies. Chest 2003; 124:1834–1840.  Back to cited text no. 10
    
11.
Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29:2276–2315.  Back to cited text no. 11
    
12.
Nilsson T, Söderberg M, Lundqvist G, Cederlund K, Larsen F, Rasmussen E, et al. A comparison of spiral computed tomography and latex agglutination d-dimer assay in acute pulmonary embolism using pulmonary arteriography as gold standard. Scand Cardiovasc J 2002; 36:373–377.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

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