Vascular Emergencies of the Thorax after Blunt and Iatrogenic Trauma

Hatem Alkadhi, MD ; Simon Wildermuth, MD ; Lotus Desbiolles, MD ; Thomas Schertler, MD ; David Crook, MD ; Borut Marincek, MD ; Thomas Boehm, MD

1 From the Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland (H.A., S.W., L.D., T.S., D.C., B.M.); and the Department of Radiology, Kantonsspital, Loestrasse 170, 7000 Chur, Switzerland (T.B.). Received October 30, 2003; revision requested January 5, 2004, and received February 23; accepted March 8. Supported by the NCCR CO-ME of the Swiss National Science Foundation. All authors have no financial relationships to disclose.

Multi–detector row computed tomographic (CT) angiography is an effective modality for vascular imaging in the thorax. It allows acquisition of high-resolution data sets during a single breath hold, making it the preferred method for evaluation of patients with acute vascular disease. In contrast to conventional angiography, multirow CT angiography not only depicts the vessels but also allows assessment of adjacent structures. Multirow CT angiography with two- and three-dimensional reformation can be used to diagnose vascular emergencies of the thorax after blunt and iatrogenic trauma. These include incomplete and complete aortic rupture; traumatic aortic dissection; arterial dissection and rupture after minor trauma in patients with Ehlers-Danlos syndrome; traumatic intramural hematoma; pseudoaneurysm after endovascular repair; injuries due to Swan-Ganz catheters; complications of central venous cannulation, pacemaker implantation, and percutaneous pericardial drainage; and foreign-body embolism. The diagnoses can be established with multirow CT angiography in the emergency department. Thus, the time to diagnosis can be considerably decreased by obviating conventional angiography. Knowledge of the CT findings in various vascular conditions is essential to make use of multirow CT angiography in combination with two- and three-dimensional reformation as an efficient and accurate diagnostic tool in emergency radiology.