The CXR is the next investigation commonly performed in the ED for patients presenting with chest pain following initial clinical assessment and ECG (see Figure 1). Table 11 shows the radiographic findings in conditions presenting with chest pain.
The CXR is particularly useful in patients presenting with non-cardiac chest pain and can definitively confirm a diagnosis suspected on clinical grounds (e.g. pneumothorax or pneumonia) or contribute significantly to the diagnostic process (e.g. widened mediastinum in aortic dissection or pneumomediastinum from oesophageal rupture). A normal CXR will also be helpful in making a diagnosis by excluding other potential causes for a certain clinical presentation: for example, a normal CXR in a patient with respiratory distress, pleuritic pain and hypoxia will exclude pneumothorax, make pneumonia unlikely, and increase the probability of pulmonary embolism.
There are no specific diagnostic findings on chest radiography associated with ACS; the usefulness of the CXR in this setting is to exclude other (non-cardiac) causes of chest pain or to evaluate complications of AMI (e.g. pulmonary oedema).
Condition | Radiocraphic Finding | Comment |
---|---|---|
Acute coronary syndrome | No specific radiographic finding | |
Aortic dissection | Mediastinal widening Abnormal aortic contour Globular heart shadow (haemopericardium) Pleural effusion (haemothorax) |
Suggestive in context Unusual finding Rare finding Rare finding |
Pneumothorax | Absence of pulmonary vascular markings | Diagnostic |
Tension pneumothorax | Absence of pulmonary vascular markings Mediastinal displacement |
Diagnostic Diagnostic |
Pneumonia | Localised or diffuse pulmonary infiltration Localised pulmonary atelectasis/consolidation |
Diagnostic in context |
Pulmonary embolism | Normal chest radiograph Localised pulmonary atelectasis Small pleural effusion |
Suggestive in context Rare finding Rare finding |
Oesophageal rupture | Pneumomediastinum | Diagnostic in context |
Mediastinitis | Pneumomediastinum | Diagnostic in context |
Pericarditis | Globular heart shadow | Pericardial effusion |
Myocarditis | Enlarged cardiac shadow | Dilated cardiomyopathy |