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Imaging of Non-vascular Thoracic Pain

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Pain Imaging

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Abstract

Acute chest pain is one of the most frequent requests for seeking medical attention in the emergency department. For patients suffering from chest pain, ruling out cardiovascular diseases is mandatory. Nevertheless, chest pain of noncardiac origin is frequent and includes a large variety of clinical conditions, such as parenchymal, pleural, musculoskeletal, oesophageal, psychogenic or neurologic diseases. Various imaging modalities, along with clinical and hematologic evaluation, are needed to evaluate and characterize such heterogeneous group of pathologies. Chest radiography (CXR) is almost always the first imaging technique used to define the underlying disease (i.e. parenchymal, pleural, musculoskeletal). Nevertheless, given its non-specific findings, further imaging techniques are frequently requested. A pivotal role is played by computed tomography (CT), the latter capable of determining location, nature and extent of various diseases. Ultrasonography (US), magnetic resonance imaging (MRI) and positron emission tomography (PET) play a secondary role for the evaluation of acute chest pain, being most frequently used in specific settings.

In this chapter, the authors review the most common conditions causing non-cardiovascular chest pain, highlighting the main imaging pearls and pitfalls, as well as the most relevant differential diagnoses.

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Author information

Authors and Affiliations

  1. Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy

    Gianluca Milanese & Nicola Sverzellati

  2. Section of Radiology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Aldo Carnevale

  3. Department of Radiology, Hospital Garcia de Orta, Almada, Portugal

    João Cruz

Authors
  1. Gianluca Milanese
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  2. Aldo Carnevale
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  3. João Cruz
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  4. Nicola Sverzellati
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Corresponding author

Correspondence to Nicola Sverzellati .

Editor information

Editors and Affiliations

  1. Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Maria Assunta Cova

  2. Department of Radiology, Maggiore Hospital, Trieste, Italy

    Fulvio Stacul

11.1 Electronic Supplementary Material

Pancoast tumour. Contrast-enhanced CT images (soft tissue reconstruction algorithm) show a soft tissue mass in the apicoposterior segment of the left lung, infiltrating into an ipsilateral neural foramen causing radicular pain. (MP4 2102 kb)

Mesothelioma. 18F-FDG PET-CT of a patient suffering from right pleural mesothelioma, demonstrating the chest wall invasion by a tumoural nodule with high tracer uptake (MP4 935 kb)

Video 11.6

Pleural empyema. Contrast enhanced CT images (soft tissue reconstruction algorithm) show a right-sided loculated pleural collection, with thickening and contrast enhancement of the pleural layers (GIF 26616 kb)

Video 11.9a

Tietze’s syndrome. (a) Coronal T1-WI TSE sequence of the right sternoclavicular joint depicting subchondral bone oedema on both articular surfaces. (GIF 161 kb)

Video 11.9b

Tietze’s syndrome. (b) MR Axial T1-WI SPIR TSE sequence after contrast administration shows contrast enhancement of articular and periarticular structures. (GIF 414 kb)

Video 11.10a

SAPHO syndrome. (a) CT images (bone window) depict diffuse sclerosis and hyperostosis of both clavicles and sternal manubrium with concomitant osteolytic lesion of the right clavicle (GIF 33522 kb)

Video 11.10b

SAPHO syndrome. (b) MR axial STIR sequence shows diffuse bone oedema. (GIF 1918 kb)

Video 11.11a

Ewing sarcoma. (a) Axial contrast enhanced CT images show a soft tissue mass causing destruction of the posterior arch of the ninth left rib with spiculated periosteal reaction (GIF 8150 kb)

Video 11.11b

Ewing sarcoma. (b) MR axial T1-WI TSE sequence after contrast administration shows a heterogeneous soft tissue mass with intense and diffuse contrast enhancement (GIF 1196 kb)

Video 11.14

Oesophageal perforation. Axial contrast enhanced CT images of a male patient with chest pain and hematemesis after an endoscopic procedure causing an oesophageal perforation. CT imaging allows the detection of pneumomediastinum (GIF 33342 kb)

Video 11.15a

Aorto-oesophageal fistula. (a) Native CT image of a female patient with digestive haemorrhage and previous diagnosis of type B aortic dissection showing hyperdense material in the gastric lumen consistent with blood clots. (GIF 29865 kb)

Video 11.15b

Aorto-oesophageal fistula. (b) Contrast enhanced CT images depict a lack of visualization of fatty planes between the oesophagus and thoracic descending aorta (at a carinal level) (GIF 46934 kb)

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Milanese, G., Carnevale, A., Cruz, J., Sverzellati, N. (2019). Imaging of Non-vascular Thoracic Pain. In: Cova, M., Stacul, F. (eds) Pain Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-99822-0_11

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  • DOI: https://doi.org/10.1007/978-3-319-99822-0_11

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