6. Emergency Chest Imaging

Question 1

Life threatening conditions that result in chest pain as chief complaint

Answer 1

• acute coronary syndrome
• aortic dissection
• pulmonary embolism
• tension pneumothorax
• pericardial tamponade
• mediastinitis (esophageal rupture)

Question 2

What is the “triple-rule-out” CT?

Answer 2

• cardiac CT protocol that aims to assess different problems at the same time
• obstructive coronary disease
• aortic dissection
• pulmonary embolism

Question 3

Pulmonary embolism on chest X-ray

Answer 3

• not specific
• rarely visible
• it can be used to exclude other chest pathologies in hemodynamically stable patients

Question 4

Pulmonary embolism on CT angiography

Answer 4

• iodine-based iv. contrast material
• bolus tracking method
• gold-standard for pulmonary embolism
• hypodense filling defect in the pulmonary vessels can be visible

Question 5

Imaging of aortic aneurysm

Answer 5

• DSA: true size may not be seen due to thrombosis in the wall; necessary for surgical/interventional planning
• US: adequate screening and follow-up
• CT(A): necessary for surgica/interventional planning
• MR(A): alternative to CT in case of renal insufficiency or pregnancy

Question 6

Treatment of aortic dissection

Answer 6

• Stanford type A: urgent cardiac surgery is required due to high risk of coronary obstruction and sudden cardiac death
• Stanford type B: can be treated conservatively

Question 7

Chest X-ray in tension pneumothorax

Answer 7

• acute, life-threatening condition
• no time for imaging in most cases
• in very select cases, it may be preferable to confirm and localize PTX radiologically
• therapy: immediate decompression with 14 or 16 G needle