Multi-slice computed tomography (MSCT) coronary angiography is an imaging modality that can identify patients with both soft and hard plaque, supplementing the information gleaned from an ordinary coronary calcium scan and classic risk-factor assessment. Clinicians now have the tools to identify the presence of coronary artery disease (CAD) in the presymptomatic phase, as well as those needed to help identify the etiology of pain syndromes in patients presenting with atypical or obscure symptoms and who may be suffering from obstructive CAD, aortic dissection, pulmonary emboli, or other pathologic processes. There is considerable training and practice involved in developing the skills necessary to convert raw information from a CT scanner to optimal diagnostic images; however, MSCT provides important diagnostic information in a faster, less expensive, more patient-friendly, and safer manner than conventional coronary angiography. The following 2 cases describe the use of MSCT coronary angiography in patients with atypical symptoms and exemplify the use of this technology in a clinical setting.