The main objective of this review is to describe the main imaging findings of the CT hypotension complex. The vascular and visceral signs commonly observed will be described.

CT hypotension complex is a constellation of imaging features observed in the context of severe hypotension. Taylor et al. initially described the hypoperfusion complex in a series of pediatric patients. This complex was firstly named “shock bowel” due to the characteristic findings in the bowel in patients with hypovolemic shock secondary to trauma (1). It is more common in children compared to adults (2). Although this entity was first described in trauma, this is not the only etiology of CT hypotension complex. Other causes include...

A spectrum of vascular and visceral CT signs is described. The presence of 2 or more vascular or visceral signs is required to establish the presence of CT hypotension complex (4). Vascular signs include diminished inferior vena cava diameter, diminished aortic diameter and abnormal vascular enhancement (7).Imaging findings may be reversible on an early stage. Vascular signs: Inferior vena cava collapse or Slit sign: Explained by a reduced venous return and severe vasoconstriction. A positive sign is considered when the anteroposterior diameter is less than...

The CT hypotension complex is associated with a high morbidity and mortality. It causes severe hypoperfusion to abdominal organs, presenting with multiple vascular and visceral imaging features. Clinical markers of shock, such as hypotension and tachycardia, are not always present at the beginning. The radiologist plays a key role in early diagnosis of hypoperfusion complex to aid in the triage and management of patients and improve their prognosis.

1. Ames JT, Federle MP. CT Hypotension Complex (Shock Bowel) Is Not Always Due to Traumatic Hypovolemic Shock. Am J Roentgenol. 2009 May;192(5):W230–5. 2. Prasad KR, Kumar A, Gamanagatti S, Chandrashekhara SH. CT in post-traumatic hypoperfusion complex—a pictorial review. Emerg Radiol. 2011 Apr;18(2):139–43. 3. Higashi H, Kanki A, Watanabe S, Yamamoto A, Noda Y, Yasokawa K, et al. Traumatic hypovolemic shock revisited: the spectrum of contrast-enhanced abdominal computed tomography findings and clinical implications for its management. Jpn J Radiol. 2014 Oct;32(10):579–84. 4. Wang J, Liang...