 Introduction/Background Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings. Of the many causes for undifferentiated chest pain, acute cardiovascular processes (eg, myocardial infarction or aortic dissection) are the most important to distinguish from less life-threatening etiologies. Distinguishing visceral (eg, angina) from musculoskeletal (ie, chest wall) pain is an essential step in the diagnostic approach. An estimated 20% to 40% of the general population may be affected by chest pain in their lifetime [1], and almost half of patients presenting to primary care settings with chest pain were diagnosed with musculoskeletal causes. Patients presenting to ambulatory care settings more often are found to have noncardiovascular causes of chest pain (musculoskeletal, gastrointestinal, and psychopathologic) than those presenting to emergency departments [1,2]. One large series of ambulatory patients described their chest wall symptoms as stinging (53.0%) or pressing (35.1%), retrosternal (52.0%) or left-sided (69.2%), occurring more than once daily (62.9%), with more than half (55.4%) having chronic symptoms lasting >6 months [1]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Discussion of Procedures by Variant Variant 1: Nontraumatic chest wall pain. No history of malignancy. Initial imaging.
Nontraumatic Chest Wall Pain.  Introduction/Background Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings. Of the many causes for undifferentiated chest pain, acute cardiovascular processes (eg, myocardial infarction or aortic dissection) are the most important to distinguish from less life-threatening etiologies. Distinguishing visceral (eg, angina) from musculoskeletal (ie, chest wall) pain is an essential step in the diagnostic approach. An estimated 20% to 40% of the general population may be affected by chest pain in their lifetime [1], and almost half of patients presenting to primary care settings with chest pain were diagnosed with musculoskeletal causes. Patients presenting to ambulatory care settings more often are found to have noncardiovascular causes of chest pain (musculoskeletal, gastrointestinal, and psychopathologic) than those presenting to emergency departments [1,2]. One large series of ambulatory patients described their chest wall symptoms as stinging (53.0%) or pressing (35.1%), retrosternal (52.0%) or left-sided (69.2%), occurring more than once daily (62.9%), with more than half (55.4%) having chronic symptoms lasting >6 months [1]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Discussion of Procedures by Variant Variant 1: Nontraumatic chest wall pain. No history of malignancy. Initial imaging.