Abdominal Vascular Emergencies in MDCT Imaging Poster No.: C-0913 Congress: ECR 2016 Type: Educational Exhibit Authors: K. SHIRODKAR, D. N. Dasappa, S. L. DEVARU, D. S. 1 2 2 2 2 2 1 Nandikoor, A. R. Patil, D. G. m j ; MAPUSA, GOA, GOA/IN, 2 BANGALORE/IN Keywords: Abdomen, Emergency, Vascular, CT, CT-Angiography, Computer Applications-Detection, diagnosis, Complications, Education, Trauma, Aneurysms, Dissection DOI: 10.1594/ecr2016/C-0913 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 19
Learning objectives 1. 2. 3. 4. Review the various traumatic abdominal vascular emergencies encountered on MDCT Review the various Non-traumatic abdominal vascular emergencies encountered on MDCT Discuss salient imaging features on MDCT Management stratergies for treating the vascular emergencies Background Abdominal vascular emergencies are life threatening and require a high index of clinical suspicion MDCT has the advantage of being fast and non-invasive; and is rapidly becoming the preferred imaging modality in acute vascular emergencies. Vascular injuries can be traumatic or non-traumatic and can be arterial as well as venous in nature Prompt recognition of vascular insults and their rapid treatment are essential for a suscessful outcome as hypovolemia and end organ infarction can cause the patient to spiral downhill Findings and procedure details TRAUMATIC Traumatic arterial injuries Traumatic venous injuries Visceral arterial trauma Vascular pelvic trauma NON-TRAUMATIC Abdominal aortic aneurysms (Rupture and impending rupture ) Acute aortic dissection Vasculitis Post surgical vascular graft occlusion Page 2 of 19
Endoleaks Post Procedure complications Spontaneous abdominal bleeding Acute mesenteric ischemia Pancreatitis Sequlae Vascular torsion (Ovarian and Bowel Torsion ) Images for this section: Fig. 1: TRAUMATIC ARTERIAL INJURIES Page 3 of 19
Fig. 2: TRAUMATIC VENOUS INJURIES Page 4 of 19
Fig. 3: TRAUMATIC VISCERAL INJURIES Page 5 of 19
Fig. 4: TRAUMATIC PELVIC INJURIES Page 6 of 19
Fig. 5: ABDOMINAL AORTIC ANEURYSM Page 7 of 19
Fig. 6: ACUTE AORTIC DISSECTION Page 8 of 19
Fig. 7: VASCULITIS Page 9 of 19
Fig. 15: Post Surgical Vascular Graft Occlusion Page 10 of 19
Fig. 14: Endoleaks Page 11 of 19
Fig. 8: Post procedure complications Page 12 of 19
Fig. 9: Spontaneous Abdominal Bleeding Page 13 of 19
Fig. 10: Acute Mesenteric ischaemia Page 14 of 19
Fig. 11: Sequlae of Pancreatitis Page 15 of 19
Fig. 12: Ovarian Torsion Page 16 of 19
Fig. 13: Bowel Torsion Page 17 of 19
Conclusion MDCT provides a fast and non inavsive method of detecting vascular emergencies and overcomes the limitations of ultrasound It helps in quick diagnosis and saves valauble time for appropriate intervention in an emergency life threatening scenario It also helps in diagnosing post procedural complications and guides appropriate management Personal information References Frauenfelder T, Wildermuth S, Marincek B, Boehm T. Nontraumatic Emergent Abdominal Vascular Conditions: Advantages of Multi-Detector Row CT and Three-Dimensional Imaging 1. Radiographics. 2004 Mar;24(2):481-96. Genovese EA, Fonio P, Floridi C, Macchi M, Maccaferri A, Ianora AA, Cagini L, Carrafiello G. Abdominal vascular emergencies: US and CT assessment. Critical ultrasound journal. 2013 Jul 15;5(Suppl 1):S10. Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012 Dec 1. Heiken JP, Katz DS. Emergency Radiology of the Abdomen and Pelvis: Imaging of the Nontraumatic and Traumatic Acute Abdomen. InDiseases of the Abdomen and Pelvis 2014-2017 2014 Jan 1 (pp. 3-20). Springer Milan. Frauenfelder T, Wildermuth S, Marincek B, Boehm T. Nontraumatic Emergent Abdominal Vascular Conditions: Advantages of Multi-Detector Row CT and Three-Dimensional Imaging 1. Radiographics. 2004 Mar;24(2):481-96. Novelline RA, Rhea JT, Rao PM, Stuk JL. Helical CT in Emergency Radiology 1. Radiology. 1999 Nov;213(2):321-39. Willmann JK, Roos JE, Platz A, Pfammatter T, Hilfiker PR, Marincek B, Weishaupt D. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. American Journal of Roentgenology. 2002 Aug;179(2):437-44. Page 18 of 19
Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR. American journal of roentgenology. 1993 Jul;161(1):65-9. Siegel CL, Cohan RH. CT of abdominal aortic aneurysms. AJR. American journal of roentgenology. 1994 Jul;163(1):17-29. Klar E, Rahmanian PB, Bücker A, Hauenstein K, Jauch KW, Luther B. Acute mesenteric ischemia: a vascular emergency. Deutsches Ärzteblatt international. 2012 Apr;109(14):249. Page 19 of 19