الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
A large number of patient present to the ED with undifferentiated chest pain, which remains a formidable clinical challenge.Numerous vascular and non-vascular chest problems, such as pulmonary embolism (PE), aortic dissection, or acute coronary syndrome, as well as pulmonary, pleural, or osseous lesions, must be taken into account.Nowadays, contrast-enhanced multidetector row computed tomography (CT) has replaced previous invasive diagnostic procedures and currently represents the imaging modality of choice when the clinical suspicion of pulmonary embolism or acute aortic syndrome is raised. At the same time, multidetector CT is capable of detecting a multitude of non threatening causes of acute chest pain, such as pneumonia, pericarditis, or fractures. Recent technical advances in CT technology have also shown great advantages for non-invasive imaging of the coronary arteries With the combined use of post processing techniques, improved the overall understanding of the cardiovascular anatomical situation with proper interpretation of the data, hence better diagnosis& overall good prognosis& management.Fifty three patients were included in the study,30 of them underwent CT coronary angiography, 13 patients underwent CT aortography, 9 patients underwent CT pulmonary angiography& 1 patient underwent routine CT examination of the chest.Results showed that out of the 53 patients, 19 of them suffer from acute coronary syndrome, 5 from pulmonary embolism and 10 from acute aortic lesions. One of the patients had acute chest pain from fractured rib and 18 others had normal CT findings.Regarding the CT coronary patients group, as compared to the coronary catheterization results, receiver operating characteristics (ROC) curve showed sensitivity of 88.2% specificity of 43% positive predictive value of 60%, negative predictive value of 78.5% with diagnostic accuracy of 75%.The five patients who diagnosed to have Pulmonary Embolism were hospitalized with admission in the Intensive Care Unit (ICU), D-Dimer was requested, and confirmed the diagnosis& medical treatment started immediately, follow up shows clinical improvement and all patients were discharged.The ten patients who diagnosed to have aortic lesions, unfortunately, two of them died before any intervention, due to rupture of the aneurysm. The other 8 patients were admitted in the hospital, 5 of them underwent urgent endovascular aortic repair (EVAR), with successful stenting and securing of the aneurysm.