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Acute chest pain is a common symptom but triage decisions in these patients remain a challenge. Patient's history, cardiac enzyme levels, or electrocardiograms often are unspecific. Nowadays, multidetector-row computed tomography (CT) currently represents the imaging modality of choice for diagnosing or excluding pulmonary embolism (PE) or acute aortic syndrome (AAS). Furthermore, recent studies have demonstrated advantages for non-invasive imaging of the coronary arteries by CT. The so called triple rule-out CT allows the depiction of the pulmonary arteries, the thoracic aorta, and the coronary arteries within a single examination with a simultaneous attenuation of these three vessel territories. This enables the detection of life-threatening such as PE, AAS and ACS, as well as of non-life-threatening diseases causing acute chest pain.