Overlooked Acute Myocardial Infarction and Intramural Hematoma on Abdominal CT in Patients Presenting with Nonspecific Abdominal Pain

Objectives: The field of view on abdominal CT includes the lower portion of the heart and thoracic aorta. Notably, triple rule-out (TRO) abnormalities [acute myocardial infarction (AMI), acute aortic syndrome (AAS), and pulmonary thromboembolism (PE)] may be overlooked on abdominal CT. The purpose of this paper is to evaluate the frequency of overlooked TRO abnormalities on abdominal CT in patients presenting with nonspecific abdominal pain. Methods: We retrospectively identified 913 patients from January 2017 to June 2018 in whom enhanced abdominal CT was performed due to nonspecific abdominal pain. Two chest radiologists retrospectively assessed the abdominal CT, focusing on whether TRO abnormalities were overlooked. Results: Upon retrospective review, there were 0.5% TRO abnormalities (four AMI and one AAS) not described on abdominal CT. A majority (71.4%) of the TRO abnormalities were overlooked on the initial CT report. Conclusions: Radiologists should routinely assess the lower chest on abdominal CT to avoid overlooked TRO abnormalities.