Type:
Educational Exhibit
Keywords:
Haemorrhage, Embolisation, CT-Angiography, CT, Catheter arteriography, Emergency, Abdomen
Authors:
B. ALPARSLAN1, N. YILDIRIM1, B. Hakyemez2, A. Ozer1, G. Savci1; 1Bursa/TR, 2Türkiye/Bursa/TR
DOI:
10.1594/ecr2012/C-2495
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 the treatment modality: conservative,
coil embolization or laparotomy.
At this point ‘multiphasic imaging’ helps us to distinguish:
active bleeding from contained vascular injury
& arterial bleeding from venous bleeding
![](https://epos.myesr.org/posterimage/esr/ecr2012/109014/media/412757?maxheight=300&maxwidth=300)
Table 1
Multiphasic imaging:
Arterial phase *
20-25’’
Venous phase
60-70’’
Delayed phase *
5-15’
* X-ray dose should be modified !
![](https://epos.myesr.org/posterimage/esr/ecr2012/109014/media/412768?maxheight=300&maxwidth=300)
Table 2