CT coronary angiography in the investigation of chest pain--beyond coronary artery atherosclerosis; a pictorial review

Obstructive coronary artery disease due to atherosclerosis remains the commonest cause of chest pain, although several other conditions involving the coronary arteries, cardiac and non-cardiac structures can also result in chest pain syndromes. CT coronary angiography (CTCA) provides a non-invasive method for anatomical imaging of coronary artery disease. Whilst it does not replace diagnostic angiography, it provides a reliable 'rule out' of significant coronary artery disease in at least low to intermediate risk groups. The ability of CTCA to provide volumetric data with a large field of view also facilitates its use in the diagnosis of patients presenting with chest pain. The purpose of this pictorial review is to describe non-atherosclerotic pathologies which may present with chest pain identifiable on CTCA.