Pain Imaging pp 171-194 | Cite as

Imaging of Vascular Thoracic Pain

  • Manuel BelgranoEmail author
  • Matilda Muça


Chest pain is the most common cause of first aid access in the emergency room and causes high mortality if not treated properly.

A high accuracy and efficiency of the evaluation of patients with acute chest pain is necessary; in this context, multi-slice computed tomography (MSCT) is a first-line tool for the anatomic evaluation of coronary artery disease, exclusion of pulmonary embolism, and aortic dissection. Magnetic resonance imaging is complementary to CT and is difficulty available in emergency setting.

Both techniques are the main tools to manage the patient with chest pain, and their presence is mandatory in a first-level hospital.


CT angiography Cardiac CT Cardiac MR Dissection Aneurysm 

Supplementary material

Video 10.1

Aortic dissection; ECG-triggered CT angiography shows the typical linear filling defect within the lumen representing the intimal flap. (MOV 31666 kb)

Video 10.2

ECG-triggered CT angiography of dissected aorta reconstructed in both systolic and diastolic phases shows the intimal flap waving during the cardiac cycle changing its orientation. (MOV 790 kb)

Video 10.3

Cardiac MR shows pericardial thickening associated with late enhancement in a patient with pericarditis. (MOV 3196 kb)


  1. 1.
    Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med. 2000;342(16):1187–95.PubMedGoogle Scholar
  2. 2.
    Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342(16):1163–70.PubMedGoogle Scholar
  3. 3.
    Sabatine MS, Cannon CP. Approach to the patient with chest pain. Philadelphia: Elsevier; 2012. p. 1076–86.Google Scholar
  4. 4.
    Morrow DA. Clinical application of sensitive troponin assays. N Engl J Med. 2009;361(9):913–5.PubMedGoogle Scholar
  5. 5.
    Amsterdam EA, Kirk JD, Diercks DB, Lewis WR, Turnipseed SD. Exercise testing in chest pain units: rationale, implementation, and results. Cardiol Clin. 2005;23(4):503–16. vii.PubMedGoogle Scholar
  6. 6.
    Ekelund U, Forberg JL. New methods for improved evaluation of patients with suspected acute coronary syndrome in the emergency department. Emerg Med J. 2007;24(12):811–4.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Ottani F, Binetti N, Casagranda I, Cassin M, Cavazza M, Grifoni S, Lenzi T, Lorenzoni R, Sbrojavacca R, Tanzi P, Vergara G. Percorso di valutazione del dolore toracico. Valutazione dei requisiti di base per l'implementazione negli ospedali italiani ANMCO.Google Scholar
  8. 8.
    Conti A, Paladini B, Toccafondi S, Magazzini S, Olivotto I, Galassi F, et al. Effectiveness of a multidisciplinary chest pain unit for the assessment of coronary syndromes and risk stratification in the Florence area. Am Heart J. 2002;144(4):630–5.PubMedGoogle Scholar
  9. 9.
    Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56(22):1864–94.Google Scholar
  10. 10.
    Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation. 2004;110(5):588–636.PubMedGoogle Scholar
  11. 11.
    Stern S. Symptoms other than chest pain may be important in the diagnosis of “silent ischemia,” or “the sounds of silence”. Circulation. 2005;111(24):e435–7.PubMedGoogle Scholar
  12. 12.
    Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000;283(24):3223–9.Google Scholar
  13. 13.
    Culic V, Eterovic D, Miric D, Silic N. Symptom presentation of acute myocardial infarction: influence of sex, age, and risk factors. Am Heart J. 2002;144(6):1012–7.PubMedGoogle Scholar
  14. 14.
    Binetti N, Lenzi T, Strada A. Medicina di Emergenza-Urgenza. Approccio al paziente con dolore toracico. Amsterdam: Elsevier; 2011. p. 345–9.Google Scholar
  15. 15.
    Dastidar AG, Rodrigues JC, Ahmed N, Baritussio A, Bucciarelli-Ducci C. The role of cardiac MRI in patients with troponin-positive chest pain and unobstructed coronary arteries. Curr Cardiovasc Imaging Rep. 2015;8(8):28.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Karlson BW, Herlitz J, Wiklund O, Richter A, Hjalmarson A. Early prediction of acute myocardial infarction from clinical history, examination and electrocardiogram in the emergency room. Am J Cardiol. 1991;68(2):171–5. Google Scholar
  17. 17.
    Sabia P, Afrookteh A, Touchstone DA, Keller MW, Esquivel L, Kaul S. Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. Circulation. 1991;84(3 Suppl):I85–92.PubMedGoogle Scholar
  18. 18.
    Jeroudi MO, Cheirif J, Habib G, Bolli R. Prolonged wall motion abnormalities after chest pain at rest in patients with unstable angina: a possible manifestation of myocardial stunning. Am Heart J. 1994;127:1241–50.PubMedGoogle Scholar
  19. 19.
    Schinkel AF, Bax JJ, Geleijnse ML, Boersma E, Elhendy A, Roelandt JR, et al. Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography? Eur Heart J. 2003;24(9):789–800.PubMedGoogle Scholar
  20. 20.
    Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Peterson ED, Hendel RC, et al. ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography. A report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. Catheter Cardiovasc Interv. 2008;71(5):E1–19.Google Scholar
  21. 21.
    Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on the management of stable angina pectoris: executive summary: the task force on the management of stable Angina Pectoris of the European society of cardiology. Eur Heart J. 2006;27(11):1341–81.PubMedGoogle Scholar
  22. 22.
    Marcassa C, Bax JJ, Bengel F, Hesse B, Petersen CL, Reyes E, et al. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement. Eur Heart J. 2008;29(4):557–63.PubMedGoogle Scholar
  23. 23.
    Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, et al. Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging. 2004;31(2):261–91.PubMedGoogle Scholar
  24. 24.
    Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003;108(14):1664–72.PubMedGoogle Scholar
  25. 25.
    Hoffmann U, Bamberg F, Chae CU, Nichols JH, Rogers IS, Seneviratne SK, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (rule out myocardial infarction using computer assisted tomography) trial. J Am Coll Cardiol. 2009;53(18):1642–50.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Dedic A, Ten Kate GJ, Neefjes LA, Rossi A, Dharampal A, Rood PP, et al. Coronary CT angiography outperforms calcium imaging in the triage of acute coronary syndrome. Int J Cardiol. 2013;167(4):1597–602.PubMedGoogle Scholar
  27. 27.
    Dewey M, Rief M, Martus P, Kendziora B, Feger S, Dreger H, et al. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial. BMJ. 2016;355:i5441.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Genders TS, Petersen SE, Pugliese F, Dastidar AG, Fleischmann KE, Nieman K, et al. The optimal imaging strategy for patients with stable chest pain: a cost-effectiveness analysis. Ann Int Med. 2015;162(7):474–84.PubMedGoogle Scholar
  29. 29.
    Schlattmann P, Schuetz GM, Dewey M. Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis. Eur Radiol. 2011;21(9):1904–13.PubMedGoogle Scholar
  30. 30.
    Nieman K, Hoffmann U. Cardiac computed tomography in patients with acute chest pain. Eur Heart J. 2015;36(15):906–14.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Yang L, Zhou T, Zhang R, Xu L, Peng Z, Ding J, et al. Meta-analysis: diagnostic accuracy of coronary CT angiography with prospective ECG gating based on step-and-shoot, Flash and volume modes for detection of coronary artery disease. Eur Radiol. 2014;24(10):2345–52.PubMedGoogle Scholar
  32. 32.
    Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European society of cardiology. Eur Heart J. 2013;34(38):2949–3003.Google Scholar
  33. 33.
    Schlett CL, Hoffmann U, Geisler T, Nikolaou K, Bamberg F. Cardiac computed tomography for the evaluation of the acute chest pain syndrome: state of the art. Radiol Clin North Am. 2015;53(2):297–305.PubMedGoogle Scholar
  34. 34.
    Schlett CL, Banerji D, Siegel E, Bamberg F, Lehman SJ, Ferencik M, et al. Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovasc Imaging. 2011;4(5):481–91.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Di Lazzaro D, Crusco F. CT angio for the evaluation of graft patency. J Thorac Dis. 2017;9(Suppl 4):S283–S8.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Chan M, Ridley L, Dunn DJ, Tian DH, Liou K, Ozdirik J, et al. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol. 2016;221:898–905.PubMedGoogle Scholar
  37. 37.
    Pesenti-Rossi D, Baron N, Georges JL, Augusto S, Gibault-Genty G, Livarek B. Assessment of coronary bypass graft patency by first-line multi-detector computed tomography. Ann Cardiol Angeiol (Paris). 2014;63(5):284–92.PubMedGoogle Scholar
  38. 38.
    Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J. 2008;29(4):531–56.PubMedGoogle Scholar
  39. 39.
    Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, et al. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94(11):1386–93.PubMedGoogle Scholar
  40. 40.
    Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43(5):842–7.PubMedGoogle Scholar
  41. 41.
    Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O’Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49(8):863–71.PubMedGoogle Scholar
  42. 42.
    Goldstein JA, Chinnaiyan KM, Abidov A, Achenbach S, Berman DS, Hayes SW, et al. The CT-STAT (coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol. 2011;58(14):1414–22.PubMedGoogle Scholar
  43. 43.
    Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012;367(4):299–308.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Litt HI, Gatsonis C, Snyder B, Singh H, Miller CD, Entrikin DW, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012;366(15):1393–403.PubMedGoogle Scholar
  45. 45.
    Raff GL, Chinnaiyan KM, Cury RC, Garcia MT, Hecht HS, Hollander JE, et al. SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2014;8(4):254–71.PubMedGoogle Scholar
  46. 46.
    Halliburton SS, Abbara S, Chen MY, Gentry R, Mahesh M, Raff GL, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 2011;5(4):198–224.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Fuchs TA, Stehli J, Bull S, Dougoud S, Clerc OF, Herzog BA, et al. Coronary computed tomography angiography with model-based iterative reconstruction using a radiation exposure similar to chest X-ray examination. Eur Heart J. 2014;35(17):1131–6.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Cademartiri F, de Monye C, Pugliese F, Mollet NR, Runza G, van der Lugt A, et al. High iodine concentration contrast material for noninvasive multislice computed tomography coronary angiography: iopromide 370 versus iomeprol 400. Invest Radiol. 2006;41(3):349–53.PubMedGoogle Scholar
  49. 49.
    Leurent G, Langella B, Fougerou C, Lentz PA, Larralde A, Bedossa M, et al. Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin, acute chest pain syndrome and unobstructed coronary arteries. Arch Cardiovasc Dis. 2011;104(3):161–70.PubMedGoogle Scholar
  50. 50.
    Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A, et al. Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis. Heart. 2011;97(16):1312–8.PubMedGoogle Scholar
  51. 51.
    Chopard R, Jehl J, Dutheil J, Genon VD, Seronde MF, Kastler B, et al. Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging. Arch Cardiovasc Dis. 2011;104(10):509–17.PubMedGoogle Scholar
  52. 52.
    Gerbaud E, Harcaut E, Coste P, Erickson M, Lederlin M, Labeque JN, et al. Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Int J Cardiovasc Imaging. 2012;28(4):783–94.PubMedGoogle Scholar
  53. 53.
    Mahmoudi M, Harden S, Abid N, Peebles C, Nicholas Z, Jones T, et al. Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI. Br J Radiol. 2012;85(1016):e461–6.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Collste O, Sorensson P, Frick M, Agewall S, Daniel M, Henareh L, et al. Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging: results from the Stockholm Myocardial Infarction with Normal Coronaries study. J Intern Med. 2013;273(2):189–96.PubMedGoogle Scholar
  55. 55.
    Kawecki D, Morawiec B, Monney P, Pellaton C, Wojciechowska C, Jojko J, et al. Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms. Med Sci Monit. 2015;21:171–80.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians, 2004. Available from:
  57. 57.
    Schepis T, Achenbach S, Marwan M, Muschiol G, Ropers D, Daniel WG, et al. Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes. Eur Radiol. 2010;20(7):1607–14.PubMedGoogle Scholar
  58. 58.
    Feuchtner GM, Plank F, Pena C, Battle J, Min J, Leipsic J, et al. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging. Heart. 2012;98(20):1510–7.PubMedGoogle Scholar
  59. 59.
    Nieman K, Cury RC, Ferencik M, Nomura CH, Abbara S, Hoffmann U, et al. Differentiation of recent and chronic myocardial infarction by cardiac computed tomography. Am J Cardiol. 2006;98(3):303–8.PubMedGoogle Scholar
  60. 60.
    Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897–903.PubMedGoogle Scholar
  61. 61.
    Holloway BJ, Rosewarne D, Jones RG. Imaging of thoracic aortic disease. Br J Radiol. 2011;84(3):S338–54.Google Scholar
  62. 62.
    von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld C, et al. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004;116:73–7.Google Scholar
  63. 63.
    Salvolini L, Renda P, Fiore D, Scaglione M, Piccoli G, Giovagnoni A. Acute aortic syndromes: role of multi-detector row CT. Eur J Radiol. 2008;65(3):350–8.PubMedGoogle Scholar
  64. 64.
    Feuchtner GM, Jodocy D, Klauser A, Haberfellner B, Aglan I, Spoeck A, et al. Radiation dose reduction by using 100-kV tube voltage in cardiac 64-slice computed tomography: a comparative study. Eur J Radiol. 2010;75(1):e51–6.PubMedGoogle Scholar
  65. 65.
    Miyazaki M, Lee VS. Nonenhanced MR angiography. Radiology. 2008;248(1):20–43.PubMedGoogle Scholar
  66. 66.
    Johansson G, Markstrom U, Swedenborg J. Ruptured thoracic aortic aneurysms: a study of incidence and mortality rates. J Vasc Surg. 1995;21(6):985–8.PubMedGoogle Scholar
  67. 67.
    Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH, et al. Contemporary results of surgery in acute type A aortic dissection: the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg. 2005;129(1):112–22.PubMedGoogle Scholar
  68. 68.
    LePage MA, Quint LE, Sonnad SS, Deeb GM, Williams DM. Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol. 2001;177(1):207–11.PubMedGoogle Scholar
  69. 69.
    Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108(Suppl 1):II312–7.PubMedGoogle Scholar
  70. 70.
    Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting death in patients with acute type a aortic dissection. Circulation. 2002;105(2):200–6.PubMedGoogle Scholar
  71. 71.
    Mehta RH, O’Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol. 2002;40(4):685–92.PubMedGoogle Scholar
  72. 72.
    Kazerooni EA, Bree RL, Williams DM. Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. Radiology. 1992;183(3):759–65.PubMedGoogle Scholar
  73. 73.
    Nienaber CA, Sievers HH. Intramural hematoma in acute aortic syndrome: more than one variant of dissection? Circulation. 2002;106(3):284–5.PubMedGoogle Scholar
  74. 74.
    Richens D, Kotidis K, Neale M, Oakley C, Fails A. Rupture of the aorta following road traffic accidents in the United Kingdom 1992–1999. The results of the co-operative crash injury study. Eur J Cardiothorac Surg. 2003;23(2):143–8.PubMedGoogle Scholar
  75. 75.
    Gotway MB, Araoz PA, Macedo TA, Stanson AW, Higgins CB, Ring EJ, et al. Imaging findings in Takayasu’s arteritis. AJR Am J Roentgenol. 2005;184(6):1945–50.PubMedGoogle Scholar
  76. 76.
    Lin MP, Chang SC, Wu RH, Chou CK, Tzeng WS. A comparison of computed tomography, magnetic resonance imaging, and digital subtraction angiography findings in the diagnosis of infected aortic aneurysm. J Comput Assist Tomogr. 2008;32(4):616–20.PubMedGoogle Scholar
  77. 77.
    Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85(6):572–93.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. 2004;43(6):1042–6.PubMedGoogle Scholar
  79. 79.
    Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003;108(9):1146–62.PubMedGoogle Scholar
  80. 80.
    Han D, Lee KS, Franquet T, Muller NL, Kim TS, Kim H, et al. Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics. 2003;23(6):1521–39.PubMedGoogle Scholar

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Authors and Affiliations

  1. 1.SC (UCO) Radiologia Diagnostica e Interventistica, Dipartimento di Scienze MedicheChirurgiche e della Salute - Università degli Studi di Trieste, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS)TriesteItaly

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