Differentials
Acute coronary syndrome
SIGNS / SYMPTOMS
Chest pain is typically central and crushing.
There may be a history of prior exertional chest pain.
INVESTIGATIONS
ECG and high-sensitivity troponin may indicate myocardial infarction or ischaemia.
ST segment depression may occur in acute dissection, but ST elevation is rare.
Pericarditis
SIGNS / SYMPTOMS
Chest pain typically pleuritic.
INVESTIGATIONS
ECG typically shows diffuse ST elevation.
Aortic aneurysm
SIGNS / SYMPTOMS
Stable (non-dissecting and non-leaking) aneurysms are usually asymptomatic. Diagnosis is usually incidental to work-up for another entity, or found through a screening programme.
INVESTIGATIONS
Computed tomography (CT) angiography of the chest does not show dissection.
Musculoskeletal pain
SIGNS / SYMPTOMS
Pain may be reproducible on palpation of the affected area.
INVESTIGATIONS
CT angiography of the chest does not show dissection.
Pulmonary embolus
SIGNS / SYMPTOMS
Dyspnoea, hypoxia, and pleuritic chest pain.
There may be evidence of deep vein thrombosis: for example, calf swelling or tenderness.
INVESTIGATIONS
CT angiography of the chest shows pulmonary embolus.
Mediastinal tumour
SIGNS / SYMPTOMS
Possible cough or haemoptysis.
INVESTIGATIONS
CT angiography of the chest shows evidence of tumour.
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