Value of triple rule-out CT in the emergency department

Triple-rule-out (TRO) computed tomographic (CT) angiography is a recent technique for evaluation of the coronary arteries, aorta, pulmonary arteries, and adjacent intrathoracic structures simultaneously for patients with acute chest pain. To assess the validity and efficacy of Triple-rule-out (TRO) computed tomographic (CT) angiography in diagnosis of different vascular causes of chest pain in the emergency department. Between April 2013 and December 2014, 40 patients presenting with non-specific acute chest pain to the emergency department performed Triple-rule-out (TRO) computed tomographic (CT) angiography utilizing a biphasic contrast injection technique. The CT angiographic images were interpreted prospectively for detection of any pulmonary, coronary or aortic vascular abnormalities. The study revealed 20 cases (50%) with only coronary lesions, 5 cases (12.5%) with only pulmonary lesions, 10 cases (25%) with only aortic lesions and 3 cases (7.5%) with combined coronary/aortic lesions. 2 cases (5%) showed no significant vascular abnormality. An optimized TRO protocol with concomitant reduced radiation exposure and efficient contrast agent administration provides a reliable tool for evaluation of coronary, aortic and pulmonary arteries in the emergency department.