Diagnostic and Prognostic Utility of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Pain in the Emergency Department

Acute undifferentiated chest pain (AUCP) is a frequent and diagnostically challenging presentation in emergency departments (EDs), encompassing life-threatening conditions such as acute coronary syndrome (ACS), pulmonary embolism (PE), aortic dissection (AD), and other non-cardiac etiologies. Comprehensive cardiothoracic computed tomography (CCT), including coronary computed tomography angiography (CCTA) and non-coronary thoracic imaging, has revolutionized the diagnostic approach to AUCP. This review evaluates the diagnostic accuracy, clinical utility, prognostic value, and cost-effectiveness of CCT in the ED, emphasizing its role in rapid risk stratification, reducing unnecessary hospitalizations, and guiding therapeutic decisions. We synthesize evidence from 2015–2025 studies to highlight CCT’s strengths, limitations, and emerging applications. While CCT offers high sensitivity and negative predictive value (NPV), considerations such as radiation exposure, contrast-related risks, and resource availability necessitate judicious use. CCT is a cornerstone of modern ED diagnostics, with potential to optimize patient outcomes through precise and timely management.