**6.6 Esophageal rupture**

*Differential Diagnosis of Chest Pain*

thrombosed.

*5.9.2 Diagnosis*

or not).

abnormality.

**6. Differential diagnosis**

**6.1 Myocardial infarction**

**6.3 Pericarditis or cardiac tamponade**

**6.4 Pulmonary embolism**

**6.5 Tension pneumothorax**

**6.2 Myocarditis**

• Not suitable for patient with renal impairment or allergic to contrast.

• The false lumen and intimal flap may not be visualized if the false channel is

• Simultaneous opacification of the true and false lumen may mask the dissection.

Diagnosis is usually done through imaging. The choice of the imaging technique depends on the patient condition (whether he is hemodynamically stable

Chest radiography is the initial basic imaging technique, but it may reveal no

with three-dimensional reconstruction are of higher diagnostic value.

In hemodynamically unstable patient, echocardiography is ideal.

AD by the typical ECG changes and the rise in the cardiac markers.

electrical alternans and enlarged cardiac shadow on the Chest X-ray.

gram is the definitive investigation to establish the diagnosis.

absent breath sounds. Diagnosis can be established by Chest X-ray.

who have adverse reaction to intravenous drug agents.

Aortography is the gold-standard diagnostic modality.

Further imaging options like computed tomography (CT) and CT angiography

Magnetic resonance imaging (MRI) is as accurate as CT and may benefit patients

Typically presents with severe substernal or left-sided chest discomfort radiating to shoulders or left arm and shortness of breath and can be differentiated from

Viral myocarditis is often preceded by flu-like symptoms, fever, joint pain, or features of upper respiratory tract infection. These patients usually present with heart failure, and ECHO is done to exclude it from other causes of heart failure.

Presents with sharp chest pain and may have a pericardial friction rub. Patients with tamponade present with cardiogenic shock and have low-voltage ECG with

Classically presents with sudden onset of chest pain, shortness of breath, and hypoxia. In patients suspected to have pulmonary embolism, CT pulmonary angio-

Patients present with sudden onset of sharp chest pain and desaturation with

• Not suitable for hemodynamically unstable patients.

**72**

Often preceded by history of forceful vomiting, upper gastrointestinal endoscopy or instrumentation. Chest X-ray shows pneumomediastinum, pneumothorax, or pleural effusion.
