Bone Scan Whole Body Bone scintigraphy using diphosphonate radiotracer has been used to detect a variety of bone diseases that may cause chest wall pain, including fractures, metastases, arthritis, osteomyelitis, osteonecrosis, and costochondritis [9], but is usually not useful as an initial imaging modality. In a retrospective study of 225 patients with atypical chest pain considered to be of low to intermediate Framingham coronary risk, Tc-99m methylene diphosphonate bone scintigraphy showed a focal abnormality in nearly half (49.4%), with most (42.7%) being posttraumatic lesions of the rib, sternum, vertebral bodies, or clavicle; 4.9% costochondritis; and 1.8% neoplastic lesions [9]. Bone scintigraphy was positive in 5/7 (71.4%) patients diagnosed with costochondritis [9]. Overall, bone scintigraphy helped determine a cause for chest pain in 94/225 (41.8%) of patients, but in 15.3% of patients with abnormalities on bone scintigraphy, the true cause for chest pain was considered irrelevant to those findings [9]. CT Chest Despite its superior sensitivity for detection and characterization of chest wall abnormalities, in the absence of other clinical risk factors like trauma, infection, or malignancy, CT may not be useful as a first-line modality for evaluation of chest wall pain [10]. For diagnosis of cough-induced rib fractures, some authors suggest that chest CT be reserved for patients who require evaluation of other pulmonary diseases [11]. Although not validated in nontraumatic settings, diagnostic accuracy for rib fractures may be improved and reading time decreased when the radiologist incorporates unfolded rib reformatted images [12,13]. Chest CT might also diagnose other causes of chest wall pain, such as mediastinal fat necrosis (also variably referred to in the literature as pericardial, epicardial, and epipericardial fat necrosis) [14].
Nontraumatic Chest Wall Pain. Bone Scan Whole Body Bone scintigraphy using diphosphonate radiotracer has been used to detect a variety of bone diseases that may cause chest wall pain, including fractures, metastases, arthritis, osteomyelitis, osteonecrosis, and costochondritis [9], but is usually not useful as an initial imaging modality. In a retrospective study of 225 patients with atypical chest pain considered to be of low to intermediate Framingham coronary risk, Tc-99m methylene diphosphonate bone scintigraphy showed a focal abnormality in nearly half (49.4%), with most (42.7%) being posttraumatic lesions of the rib, sternum, vertebral bodies, or clavicle; 4.9% costochondritis; and 1.8% neoplastic lesions [9]. Bone scintigraphy was positive in 5/7 (71.4%) patients diagnosed with costochondritis [9]. Overall, bone scintigraphy helped determine a cause for chest pain in 94/225 (41.8%) of patients, but in 15.3% of patients with abnormalities on bone scintigraphy, the true cause for chest pain was considered irrelevant to those findings [9]. CT Chest Despite its superior sensitivity for detection and characterization of chest wall abnormalities, in the absence of other clinical risk factors like trauma, infection, or malignancy, CT may not be useful as a first-line modality for evaluation of chest wall pain [10]. For diagnosis of cough-induced rib fractures, some authors suggest that chest CT be reserved for patients who require evaluation of other pulmonary diseases [11]. Although not validated in nontraumatic settings, diagnostic accuracy for rib fractures may be improved and reading time decreased when the radiologist incorporates unfolded rib reformatted images [12,13]. Chest CT might also diagnose other causes of chest wall pain, such as mediastinal fat necrosis (also variably referred to in the literature as pericardial, epicardial, and epipericardial fat necrosis) [14].