Mimics of acute coronary syndrome on MDCT

Acute coronary syndrome (ACS) encompasses a spectrum of unstable coronary artery disease ranging from transmural myocardial infarction to unstable angina. The immediate management of these patients is dictated by the presence/absence of ST segment changes on electrocardiogram. More and more patients with non-ST elevation ACS are bypassing traditional diagnostic pathways to undergo urgent coronary catheter angiography. A proportion of these patients will have normal coronary angiography and an alternative diagnosis is often sought with multi-detector computed tomography (MDCT). It is vital that clinicians and radiologists are aware of the usual and unusual mimics of ACS so they can modify their imaging technique and protocol accordingly. In this review, we present some true mimics of ACS on MDCT, from our practice, and suggest an imaging protocol that can be utilised universally.