Pain Imaging pp 195-220 | Cite as

Imaging of Non-vascular Thoracic Pain

  • Gianluca Milanese
  • Aldo Carnevale
  • João Cruz
  • Nicola SverzellatiEmail author


Acute chest pain is one of the most frequent requests for seeking medical attention in the emergency department. For patients suffering from chest pain, ruling out cardiovascular diseases is mandatory. Nevertheless, chest pain of noncardiac origin is frequent and includes a large variety of clinical conditions, such as parenchymal, pleural, musculoskeletal, oesophageal, psychogenic or neurologic diseases. Various imaging modalities, along with clinical and hematologic evaluation, are needed to evaluate and characterize such heterogeneous group of pathologies. Chest radiography (CXR) is almost always the first imaging technique used to define the underlying disease (i.e. parenchymal, pleural, musculoskeletal). Nevertheless, given its non-specific findings, further imaging techniques are frequently requested. A pivotal role is played by computed tomography (CT), the latter capable of determining location, nature and extent of various diseases. Ultrasonography (US), magnetic resonance imaging (MRI) and positron emission tomography (PET) play a secondary role for the evaluation of acute chest pain, being most frequently used in specific settings.

In this chapter, the authors review the most common conditions causing non-cardiovascular chest pain, highlighting the main imaging pearls and pitfalls, as well as the most relevant differential diagnoses.


Thorax Diagnostic imaging Musculoskeletal pain Cancer pain Pleural diseases Oesophageal diseases Thoracic wall Chest pain 

Supplementary material

Video 11.2

Pancoast tumour. Contrast-enhanced CT images (soft tissue reconstruction algorithm) show a soft tissue mass in the apicoposterior segment of the left lung, infiltrating into an ipsilateral neural foramen causing radicular pain. (MP4 2102 kb)

441208_1_En_11_MOESM2_ESM.gif (26 mb)
Video 11.6 Pleural empyema. Contrast enhanced CT images (soft tissue reconstruction algorithm) show a right-sided loculated pleural collection, with thickening and contrast enhancement of the pleural layers (GIF 26616 kb)
Video 11.8

Mesothelioma. 18F-FDG PET-CT of a patient suffering from right pleural mesothelioma, demonstrating the chest wall invasion by a tumoural nodule with high tracer uptake (MP4 935 kb)

441208_1_En_11_MOESM4a_ESM.gif (161 kb)
Video 11.9a Tietze’s syndrome. (a) Coronal T1-WI TSE sequence of the right sternoclavicular joint depicting subchondral bone oedema on both articular surfaces. (GIF 161 kb)
441208_1_En_11_MOESM4b_ESM.gif (414 kb)
Video 11.9b Tietze’s syndrome. (b) MR Axial T1-WI SPIR TSE sequence after contrast administration shows contrast enhancement of articular and periarticular structures. (GIF 414 kb)
441208_1_En_11_MOESM5a_ESM.gif (32.7 mb)
Video 11.10a SAPHO syndrome. (a) CT images (bone window) depict diffuse sclerosis and hyperostosis of both clavicles and sternal manubrium with concomitant osteolytic lesion of the right clavicle (GIF 33522 kb)
441208_1_En_11_MOESM5b_ESM.gif (1.9 mb)
Video 11.10b SAPHO syndrome. (b) MR axial STIR sequence shows diffuse bone oedema. (GIF 1918 kb)
441208_1_En_11_MOESM6a_ESM.gif (8 mb)
Video 11.11a Ewing sarcoma. (a) Axial contrast enhanced CT images show a soft tissue mass causing destruction of the posterior arch of the ninth left rib with spiculated periosteal reaction (GIF 8150 kb)
441208_1_En_11_MOESM6b_ESM.gif (1.2 mb)
Video 11.11b Ewing sarcoma. (b) MR axial T1-WI TSE sequence after contrast administration shows a heterogeneous soft tissue mass with intense and diffuse contrast enhancement (GIF 1196 kb)
441208_1_En_11_MOESM7_ESM.gif (32.6 mb)
Video 11.14 Oesophageal perforation. Axial contrast enhanced CT images of a male patient with chest pain and hematemesis after an endoscopic procedure causing an oesophageal perforation. CT imaging allows the detection of pneumomediastinum (GIF 33342 kb)
441208_1_En_11_MOESM8a_ESM.gif (29.2 mb)
Video 11.15a Aorto-oesophageal fistula. (a) Native CT image of a female patient with digestive haemorrhage and previous diagnosis of type B aortic dissection showing hyperdense material in the gastric lumen consistent with blood clots. (GIF 29865 kb)
441208_1_En_11_MOESM8b_ESM.gif (45.8 mb)
Video 11.15b Aorto-oesophageal fistula. (b) Contrast enhanced CT images depict a lack of visualization of fatty planes between the oesophagus and thoracic descending aorta (at a carinal level) (GIF 46934 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gianluca Milanese
    • 1
  • Aldo Carnevale
    • 2
  • João Cruz
    • 3
  • Nicola Sverzellati
    • 1
    Email author
  1. 1.Division of Radiology, Department of Medicine and SurgeryUniversity of ParmaParmaItaly
  2. 2.Section of Radiology, Department of Morphology, Surgery and Experimental MedicineUniversity of FerraraFerraraItaly
  3. 3.Department of RadiologyHospital Garcia de OrtaAlmadaPortugal

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