- Aortic Transection: Facts
- 10-20% of patients survive the initial event
- Occurs most commonly at aortic isthmus (space between brachiocephalic trunk and that of the ligamentum arteriosus)
- Mediastinal hematoma (anterior of posterior mediastinum) is common but not diagnostic of aortic injury
- Hematoma of interest most commonly around the aorta - Aortic Transection: Facts
- The direct signs of aortic transection include;
- Vessel caliber change
- Pseudoaneurysm
- Intramural flap - Cardiac Trauma: Differential Diagnosis
- Aortic transection
- Valvular rupture
- Hemopericardium
- Cardiac tamponade - Hypovolemic Shock: CT Findings
- Bright adrenals
- Diffuse fluid filled dilated small bowel
- Hyperenhancement of the small bowel
- Hyperenhancement of the gall bladder mucosa
- Reduced splenic perfusion
- Intense enhancement of the kidneys
- Peripancreatic edema
- Clinical Signs of Vascular Injury
Soft signs
- Significant hemorrhage found on history
- Decreased pulse compared to the contralateral extremity
- Bony injury or proximity to penetrating wound
- Neurologic abnormality - Arterial Injury: Patterns of Injury
- Hematoma
- Active extravasation
- Vasospasm
- Stenosis
- External compression
- Occlusion
- Intimal injury and dissection
- Arteriovenous fistulas
- Pseudoaneurysm formation - “ An advantage of 3D mapping is the ability to display the information in a format that not only simulates a classic catheter angiogram (digital subtraction), but also the capability to display tissue in addition to the vasculature,
including muscle, soft tissues, and bone. MIP
and VRT imaging may require segmentation with bone removal, especially when the extremities are involved. VRT is especially valuable when opaque foreign
matter is present.”
State of the art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (epub November 2012) - “A variety of factors may obscure or mimic vascular injury on MDCTA including inadequate arterial enhancement due to timing of the contrast injection, motion artifacts, inadequate positioning, streak artifacts, dense calcifications, and similar density of vessels and bone. Venous injuries may be missed on a single phase study or in the absence of late phase images.”
State of the art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (epub November 2012)
- AVFs or Arteriovenous Fistulas: Definition
-Arteriovenous Fistulas are abnormal communications with shunting of blood from am artery to a vein that mainly involve the peripheral vascular system but can affect virtually any organ or system in the body - Vascular Trauma: CT Findings Arterial injuries
- Pseudoaneurysm
- Active arterial hemorrhage
- AV fistulae
- Occlusion
- Intimal injury vasospasm "The use of multiphasic images affords more definitive characterization of areas of “contrast blush” as to the underlying etiologies of contained vascular injuries or active hemorrhage." CT of Blunt Abdominal and Pelvic Vascular Injury
Vi M et al.
Emerg Radiol (2010) 17;21-29 "Multiphasic imaging also allows for the definitive differentiation between arterial and venous sources of hemorrhage." CT of Blunt Abdominal and Pelvic Vascular Injury
Vi M et al.
Emerg Radiol (2010) 17;21-29 - CT Angiography: Potential Limitations in Extremity Trauma
- Inadequate arterial enhancement
- Motion artifact
- Inadequate positioning
- Streak artifact " By demonstrating the extent, location, and type of injury, CT angiography aids in the decision making process to determine the appropriate management for each injury in each patient." Use of 64-Row Multidetector CT Angiography in Blunt and Penetrating Trauma of the Upper and Lower Extremities
Pieroni S et al.
RadioGraphics 2009; 29:863-876 - Sixty-four-row multidetector CT angiography of the extremities has the ability to demonstrate a variety of vascular injuries such as occlusion, pseudoaneurysm, active extravasation, and intimal dissection."
Use of 64-Row Multidetector CT Angiography in Blunt and Penetrating Trauma of the Upper and Lower Extremities
Pieroni S et al.
RadioGraphics 2009; 29:863-876
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