Diagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department

Abstract

Acute Undifferentiated Chest Pain (AUCP) is a frequent and diagnostically challenging presentation in Emergency Departments (EDs), encompassing life-threatening conditions such as Acute Coronary Syndrome (ACS), Pulmonary Embolism (PE), Aortic Dissection (AD) and other non-cardiac etiologies. Comprehensive Cardiothoracic Computed Tomography (CCT), including Coronary Computed Tomography Angiography (CCTA) and non-coronary thoracic imaging, has revolutionized the diagnostic approach to AUCP. This review evaluates the diagnostic accuracy, clinical utility, prognostic value and cost-effectiveness of CCT in the ED, emphasizing its role in rapid risk stratification, reducing unnecessary hospitalizations and guiding therapeutic decisions. We synthesize evidence from 2015-2025 studies to highlight CCT’s strengths, limitations and emerging applications. While CCT offers high sensitivity and Negative Predictive Value (NPV), considerations such as radiation exposure, contrast-related risks and resource availability necessitate judicious use. CCT is a cornerstone of modern ED diagnostics, with potential to optimize patient outcomes through precise and timely management.