Imaging of Non-vascular Thoracic Pain

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.