Learning objectives
To illustrate the findings of intraabdominal active bleeding on helical CT,
MDCT and DSA.
To discuss the imaging manifestations,
protocol advices and clinical implications.
Background
Vascular injuries of abdominal and pelvic organs may cause life-threatening bleeding and it is critical to recognize the imaging findings of active bleeding immediately and direct patients to either therapeutic angiography suit for embolization or urgent laparotomy.
CECT and especially MDCT-A correctly demonstrates abdominal vessel map and integrity in a few seconds.
Hence,
these are substantial modalities in evaluating patients with suspected intraabdominal active bleeding.
Imaging findings OR Procedure details
CT findings indicative of vascular injury are:
1.
End-organ abnormalities -> hypoperfusion,
2.
Active contrast material extravasation,
3.
Irregular or indistinct contour instead of the expected smooth vascular morphology,
4.
Narrowing of the lumen of a vessel
(may be due to spasm,
perivascular hematoma,
dissection,
intramural hematoma or intimal injury with focal thrombosis),
5.
Traumatic occlusion,
evidenced by abrupt termination of the vessel,
6.Pseudoaneurysm,
arteriovenous fistulae.
Source of bleeding: artery vs.
vein ?
It is important to differentiate the source of contrast extravasation to decide...
Conclusion
1.
Radiologist should be able to recognize active contrast extravasation immediately and inform the clinician ASAP.
2.
Multiphasic imaging protocol is helpful for distinguishing active vs.
contained and arterial vs.
venous bleeding.
The radiological conclusion is included in many clinical scoring systems & changes patient management.
3.
Conservative therapy,
Embolization and Surgery are the treatment options.
Imaging has distinctive influence on the decision.
References
1.
Vu M,
Anderson SW,
Shah N,
Soto JA,
Rhea JT.
CT of blunt abdominal and pelvic vascular injury.
Emerg Radiol.
2010 Jan;17(1):21-9.
Epub 2009 Apr 21.
Review.
2. Uyeda J,
Anderson SW,
Kertesz J,
Soto JA.
Pelvic CT angiography: application to blunt trauma using 64MDCT.
Emerg Radiol.
2010 Mar;17(2):131-7.
Epub 2009 Jul9.
3.
Anderson SW,
Lucey BC,
Rhea JT,
Soto JA.
64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation.
Emerg Radiol.
2007 Jul;14(3):151-9.
Epub 2007 May 5.
4....