Imaging Pearls ❯ Trauma ❯ Musculoskeletal Trauma
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- “Traumatic arterial injuries of the extremities are a rare but potentially fatal event. Computed tomography (CT) angiography of the extremities has become the technique of choice and can provide rapid accurate detection and characterization of vascular lesions. Vascular injuries can be classified in active hemorrhage, vasospasm, occlusion, post-traumatic arteriovenous fistula, pseudoaneurysm, and patterns of intimal injuries. The learning objectives of this pictorial essay are to review the normal arterial anatomy of the upper and lower limbs, describe the technique of CT angiography in vascular trauma of the extremities, describe and illustrate the CT-angiography findings of traumatic arterial injuries, and know the potential pitfalls when interpreting a CT-angiography of the extremities.”
Traumatic arterial injuries in upper and lower limbs: what every radiologist should know
Zhao Hui Chen Zhou et al.
Emergency Radiology (2022) 29:781–790
- Objective: To assess a radiologist’s detection rate of rib fractures in trauma CT when reading curved planar reformats (CPRs) of the ribs compared to reading standard MPRs.
Results: The reference standard identified 361 rib fractures in 61 patients. Reading CPRs showed a significantly higher overall sensitivity (P<0.001) for fracture detection than reading standard MPRs, with 80.9 % (584/722) and 71.5 % (516/ 722), respectively. Mean reading time was significantly shorter for CPRs (31.3 s) compared to standard MPRs (60.7 s; P<0.001).
Conclusion: Using CPRs for the detection of rib fractures accelerates the reading of trauma patient chest CTs, while offering an increased overall sensitivity compared to conventional standard MPRs.
The ribs unfolded- a CT visualization algorithm for fast detection of rib fractures: effect on sensitivity and specificity in trauma patients
Ringl H et al.
Eur Radiol (2015) 25:1865–1874 - “In summary, the unfolded view enabled significant time savings in the detection of rib fractures, regardless of the reader’s experience. In terms of diagnostic accuracy, no advantage was noticeable for the experienced reader, whereas the inexperienced reader clearly benefited from the simpler assessability. Therefore, one can conclude that the unfolded view can be a helpful diagnostic tool for the rapid assessment of patients with blunt thorax trauma.”
Assessment of Rib Fracture in Acute Trauma Using Automatic Rib Segmentation and a Curved, Unfolded View of the Ribs: Is There a Saving of Time?
Benedikt Pregler et al.
J. Clin. Med. 2022, 11, 2502.
- "CR provides a more detailed visualization of multifragmentary intraarticular lower extremity fractures with improved image quality and higher anatomical accuracy compared to VRT, thus facilitating the understanding of fracture morphology in multifragmentary intraarticular fractures. Therefore, CR improves traumatological preoperative fracture visualization in patients with multifragmentary in- traarticular lower extremity fractures and thus can be recommended for fracture demonstration during interdisciplinary conferences.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lowerextremity fractures?
Lena M. Wollschlaegera et al.
Eur J Radiol. 2020;126:108911. doi:10.1016/j.ejrad.2020.108911 - “In summary, CR is a promising new technique for the display of reconstructed 3D MDCT data and the images provide a level of photorealistic detail that has never before been available from non-invasive medical imaging. However, the utility of these reconstructions has yet to be assessed in large clinical studies. The potential translation of these remarkably detailed reconstructions into routine clinical practice and an understanding of their advantages and disadvantages relative to traditional 3D techniques will require a systematic series of quantitative and qualitative studies.”
CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering.
Rowe, S.P., Fritz, J. & Fishman, E.K.
Emerg Radiol 25, 93–101 (2018).
- Purpose: Cinematic rendering (CR), a recently launched, FDA-approved rendering technique converts CT image datasets into nearly photorealistic 3D reconstructions by using a unique lighting model. The purpose of this study was to compare CR to volume rendering technique (VRT) images in the preoperative visualization of multifragmentary intraarticular lower extremity fractures.
Conclusions: CR reconstructions are superior to VRT due to higher image quality and higher anatomical accuracy. Traumatologists find CR reconstructions to improve visualization of lower extremity fractures which should thus be used for fracture demonstration during interdisciplinary conferences.
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - "CR uses a unique lighting model which is far more complex than the ray casting methods used in VR [5]. In CR, the algorithm is based on the global illumination model. This model incorporates information of billions of photons traveling through the volumetric dataset, and the interactions of these rays of light with a joining voxels. Complex lighting effects such as refraction, absorption, depth of field, soft shadows and ambient occlusion can be created.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - "Recently, Dappa et al. published a review comparing the potential value of CR to conventional VRT images and illustrated potential clinical applications of CR such as preoperative treatment planning. In their experience, CR is especially striking for visualizing structures with high density and high contrast such as bones. Further- more, they highlighted the high quality of CR images and their ability for the perception of depth and the photorealistic representation of human anatomy.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - “CR provides a more detailed visualization of multifragmentary intraarticular lower extremity fractures with improved image quality and higher anatomical accuracy compared to VRT, thus facilitating the understanding of fracture morphology in multifragmentary intraarticular fractures. Therefore, CR improves traumatological pre-operative fracture visualization in patients with multifragmentary in- traarticular lower extremity fractures and thus can be recommended for fracture demonstration during interdisciplinary conferences.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911
- Purpose This study compared the accuracy and timeliness of two-dimensional computed tomography (2DCT) and three- dimensional computed tomography (3DCT) in the diagnosis of different types of acetabular fractures and by different groups of interpreters using the Letournel and Judet classification system.
Conclusions Standardized 3DCT provides greater reliability and faster diagnosis of acetabular fractures and helps improve the accuracy in transverse- and posterior wall-type fractures. In addition, it helps improve the accuracy of less experienced interpreters.
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “Overall, correct classifications with 3D required just over half the time of 2D images (60 vs. 32 s, a reduction of 28 s). Significant time reductions with 3D were observed for both study groups and for all types of fractures.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “At all levels of experience among orthopedic surgeons, accuracy is greater with 3D than 2D, but the difference is more noticeable among less experienced surgeons. A study by Sebaaly et al. found 35% improvement in correct classification (from 28 to 63%) with trainees when 3D images were added but only 7% (from 85 to 92%) among the experts. Our results also noted improvement in both ac- curacy and inter-observer reliability among graduate trainees when the interpretation was performed with 3D images versus 2D.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “A 3D image set should contain a set of elec- tronic hip disarticulation images with adequate representative views using appropriate rendering techniques. Reported accuracies are higher among studies with images of hip disarticulation compared with non-hip disarticulation. A study by Boudissa et al. reported an improvement in accuracy from 52 to 83%, with the addition of hip disarticulation images, a 31% increase.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “In summary, using 3D images results in increased inter- observer reliability and faster interpretation. It helps improve accuracy in cases where classification involves simple types of fractures and also helps improve the overall accuracy of less experienced interpreters. Standardized 3D images can be produced without extensive knowledge of the Letournal classification system and are therefore appropriate for use in an emer- gency unit. We recommend routinely producing this set of 3D images for trauma patients with pelvic bone fractures.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6
- ”In the following pictorial essay, we provide a number of clinical examples of the use of CR in musculoskeletal imaging, including the evaluation of complex fractures, the delineation of the relationship of fractures to adjacent vasculature and overlying soft tissues, and the visualization of vascular and soft tissue injuries.” CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering. Rowe SP, Fritz J , Fishman EK Emerg Radiol. 2017 Sep 12. [Epub ahead of print]
- “Traumatic sternoclavicular joint dislocation is an uncommon condition whose diagnosis is often missed.The posterior version of this dislocation has been associated with multiple complications, including respiratory compromise, vascular injury, brachial plexopathy, pneumothorax, dysphagia and even death, and should be managed by timely closed or open reduction.”
Posterior sternoclavicular joint dislocation Hoekzema N et al. Can J Surg. 2008 Feb; 51(1): E19–E20. - “Posterior dislocations of the sternoclavicular joint (SCJ) are rare events, occurring most commonly from motor vehicle accidents, athletic injuries, and falls. Due to the vital structures that lie posterior to the medial clavicle, namely the innominate artery, innominate vein, trachea, esophagus, and thoracic duct, this injury is a true emergency.”
Posterior Sternoclavicular Dislocations: A Brief Review and Technique for Closed Management of a Rare But Serious Injury Deren ME et al. Orthop Rev (Pavia). 2014 Jan 20; 6(1): 5245. - “Posterior SC dislocations are rare but serious injuries due to the proximity of the medial clavicle to the vital structures of the thorax. Open techniques for fixation have associated risks and mixed outcomes for patient satisfaction based mainly on case studies and series.”
Posterior Sternoclavicular Dislocations: A Brief Review and Technique for Closed Management of a Rare But Serious Injury Deren ME et al. Orthop Rev (Pavia). 2014 Jan 20; 6(1): 5245.
- "Scapular fractures are uncommon, accounting for only 3-5% of shoulder girdle fractures and few- er than 1% of all fractures . High-energy trauma is the most common cause, and scapular fractures are frequently associated with other acute injuries, including rib fracture (53%), lung injury (47%), head injury (39%), spinal fracture (29%), and clavicle frac- ture (25%) . The initial diagnosis of scapular fracture is often delayed or ignored, because clinical care in the acute setting is focused on patient resuscitation after one or more life-threatening injuries."
Scapular Fractures: What Radiologists Need to Know
RoppAM, Davis DL
AJR 2015; 205:491-501 - "CT allows detailed characterization of bone, joint, muscle, or ligament injury at the shoulder girdle and is particularly helpful with identification of radiographically occult injuries. Thus, CT is more reliable and accurate for the detection and staging of scapular injuries than radiographs are; this is especially true for coracoid process, glenoid, and scapular neck fractures ."
Scapular Fractures: What Radiologists Need to Know
RoppAM, Davis DL
AJR 2015; 205:491-501 - "Anterior shoulder dislocation is an additional mechanism associated with intraarticular fracture of the anterior glenoid. These Ideberg type 1 fractures of the glenoid are the most typical scapular fracture pattern encountered after shoulder dislocation, with shoulder dislocations accounting for two thirds of type 1 fractures ."
Scapular Fractures: What Radiologists Need to Know
RoppAM, Davis DL
AJR 2015; 205:491-501 - "The scapula is a flat triangular bone with several distinct regions. The glenoid fossa forms the articular surface of the scapula and connects to the scapular body via the neck of the scapula. The scapula serves as an attachment site for 17 muscles, which facil- itate movement and form a functional soft- tissue envelope for the shoulder girdle. These muscles are subdivided into scapulothoracic and scapulohumeral groups. The rotator cuff muscles are a subcomponent of the scapulohumeral group."
Scapular Fractures: What Radiologists Need to Know
RoppAM, Davis DL
AJR 2015; 205:491-501 - Ideberg Classification of Intraarticular Glenoid Fractures
- “Musculoskeletal trauma accounts for a substantial number of injuries in patients sustaining polytrauma. The diagnostic work-up of those patients is challenging, complex, and requires a structured and interdisciplinary workflow. Multidetector CT (MDCT) is considered the imaging modality of choice due to remarkable technical developments in recent years. Besides the evaluation of cranial, chest, and abdominal injuries, MDCT allows for integrated imaging of musculoskeletal trauma within a single CT examination. In this context, CT angiography facilitates the detection of coexisting vascular injuries after trauma of the skeleton. In addition, recent technologies (e.g., dual-energy CT) provide promising applications such as metal artifact reduction.”
Semin Musculoskelet Radiol. 2013 Sep;17(4):371-9 Polytrauma: optimal imaging and evaluation algorithm. Semin Musculoskelet Radiol. 2013 Sep;17(4):371-9 Geyer LL et al. - “Multidetector CT (MDCT) is considered the imaging modality of choice due to remarkable technical developments in recent years. Besides the evaluation of cranial, chest, and abdominal injuries, MDCT allows for integrated imaging of musculoskeletal trauma within a single CT examination. In this context, CT angiography facilitates the detection of coexisting vascular injuries after trauma of the skeleton. In addition, recent technologies (e.g., dual-energy CT) provide promising applications such as metal artifact reduction.”
Semin Musculoskelet Radiol. 2013 Sep;17(4):371-9 Polytrauma: optimal imaging and evaluation algorithm. Semin Musculoskelet Radiol. 2013 Sep;17(4):371-9 Geyer LL et al.
- “Classically, anterior sternoclavicular dislocation is seen much more frequently, with a 20:1 ratio. This is, in part, due to a greater strength of the posterior sternoclavicular ligament compared with the anterior ligament. Four strong ligaments (intra-articular disk and costoclavicular, interclavicular, and capsular ligaments) anchor the clavicle to the sternum in a saddle-type joint that allows for both articulation and stability of the clavicle.”
Radiologic case study. Posterior Sternoclavicular Dislocation.
O'Laughlin MC et al.
Orthopedics. 2011 Jul;34(7):498, 556 - “Although rare, a posterior sternoclavicular dislocation is considered a medical emergency and requires immediate attention due to the vital structures and organs that lie immediately posterior to the joint. The innominate artery and vein lie posterior to the right sternoclavicular joint, and the trachea and esophagus lie posteromedially. On the left side, the common carotid artery and left subclavian vein are located directly posterior to the sternoclavicular joint. Compression or damage to the great vessels, trachea, esophagus, or lungs that arise from sternoclavicular dislocations could result in significant morbidity and mortality, if not properly managed.”
Radiologic case study. Posterior Sternoclavicular Dislocation.
O'Laughlin MC et al.
Orthopedics. 2011 Jul;34(7):498, 556 - “Computed tomography scanning allows for better characterization of a posterior sternoclavicular dislocation and can detect fractures that may not be appreciated on radiographs. Computed tomography angiography is recommended for the evaluation of any acute vascular injuries that may accompany a posterior sternoclavicular dislocation, and magnetic resonance imaging (MRI) can assess for neurovascular injuries if symptoms after reduction or complicated cases.”
Radiologic case study. Posterior Sternoclavicular Dislocation.
O'Laughlin MC et al.
Orthopedics. 2011 Jul;34(7):498, 556 - “Treatment methods aim to restore proper articulation of the sternoclavicular joint and are most commonly assessed by proximity of the dislocated clavicle to vital structures. However, reports in the literature differ on preferential treatment methods for posterior sternoclavicular dislocation. If there is no associated vascular compression or disruption demonstrated on CT angiography, then closed reduction within 48 hours of the injury is typically performed.”
Radiologic case study. Posterior Sternoclavicular Dislocation.
O'Laughlin MC et al.
Orthopedics. 2011 Jul;34(7):498, 556
- “Up to 10% of proximal femur fractures may be missed on initial radiographs. Current guidelines state patients should be offered MRI if hip fracture is suspected despite negative hip radiographs. Our findings show that modern multislice CT may be comparable with MRI for detecting occult fracture.”
Investigation of occult hip fractures: the use of CT and MRI.
Gill SK et al.
ScientificWorldJournal 2013;2013:830319 - “Although 64-slice CT detected the majority of occult fractures, it missed four (2%) significant fractures detected by MRI. CT scan is helpful in the diagnosis of occult hip fracture, but one should not completely exclude the diagnosis based on a negative 64-slice CT scan in a patient with persistent, localized hip pain who cannot bear weight.”
Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography
Hakkarinen DK et al.
J Emerg Med 2012 Aug;43(2) 303-7 - “Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3-4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging.”
Imaging choices in occult hip fracture
Cannon J et al.
J Emerg Med 2009 Aug;37(2):144-52
- “ Axial carpal dislocations and fracture dislocations result from high-energy dorsopalmar compression of the wrist, producing combined derangement of the distal carpal row and metacarpal arch with resultant flattening of the proximal and distal transverse arches of the wrist.”
Traumatic Axial Dislocation Injuries of the Wrist
Reinsmith LE et al.
Radiology 2013; 207:680-689 - “ Because of the extreme force of trauma causing these injuries, they may occur in association with perilunate or lunate dislocations or coincide with other complex carpal abnormalities.”
Traumatic Axial Dislocation Injuries of the Wrist
Reinsmith LE et al.
Radiology 2013; 207:680-689
- “ Advances in MDCT technology enable
high speed simultaneous evaluation of both complete lower extremities, rapid image reconstruction, and advanced
image visualization for the noninvasive and accurate diagnosisof vascular, including hematoma, active extravasation,
vasospasm, stenosis, external compression, occlusion, intimalinjury and dissection, arteriovenous fistulas, and pseudoaneurysm
formation.”
State-of-the-art 3DCT angiography assessment of lower
extremity trauma: typical findings, pearls, and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (2013) 20:175-184 - “Early venous contrast opacification can be an indirect sign of a traumatic arteriovenous fistula or can be due to trauma-related hyperemia. Arteriovenous fistulas are abnormal communications with shunting ofblood from an artery to a vein that occur after simultaneous damage of the two adjacent vessels. Common causes include penetrating trauma from gunshot injury and stab wounds.”
State-of-the-art 3DCT angiography assessment of lower
extremity trauma: typical findings, pearls, and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (2013) 20:175-184 - “MDCTA allows for rapid, noninvasive and accurate diagnosis of vascular complications in lower extremity trauma. Individualized injection protocols ensure thehighest diagnostic image quality. Several strategies are available to reduce radiation exposure. Familiarity with advanced visualization techniques will increase the radiologist’s ability to accurately identify the various signs and patterns of vascular injuries of lower extremity trauma. By demonstrating the extent, location, and type of injury, MDCTA aids in the characterization of vascular injury and helps to determine the appropriate
management.”
State-of-the-art 3DCT angiography assessment of lower
extremity trauma: typical findings, pearls, and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (2013) 20:175-184 - “A variety of factors may obscure or mimic vascular injury on MDCTA including inadequate arterial enhancement due to timing of the contrast injection, motion artifacts, inadequate positioning, streak artifacts, dense calcifications, and
similar density of vessels and bone. Venous injuries may bemissed on a single phase study or in the absence of late phase images.”
State-of-the-art 3DCT angiography assessment of lower
extremity trauma: typical findings, pearls, and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (2013) 20:175-184 - Pitfalls in CTA in Extremity Trauma
- Poor bolus injection
- Poor timing of IV injection of contrast
- Motion artifacts
- Streak artifacts off foreign matter (bullets)
- Dense calcifications
- Bone fragments can obscure bleeding site
- Venous injuries can be missed on arterial phase acquisition
- “Advances in MDCT technology enable
high speed simultaneous evaluation of both complete lower extremities, rapid image reconstruction, and advanced
image visualization for the noninvasive and accurate diagnosisof vascular injury, including hematoma, active extravasation, vasospasm, stenosis, external compression, occlusion, intimal injury and dissection, arteriovenous fistulas, and pseudoaneurysm formation.”
State of the art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (epub November 2012 - “Advances in MDCT technology enable
high speed simultaneous evaluation of both complete lower extremities, rapid image reconstruction, and advanced
image visualization for the noninvasive and accurate diagnosisof vascular injury, including hematoma, active extravasation, vasospasm, stenosis, external compression, occlusion, intimal injury and dissection, arteriovenous fistulas, and pseudoaneurysm formation.”
State of the art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (epub November 2012) 
- Clinical Signs of Vascular Injury
Hard signs
- Pulsatile hemorrhage or hematoma
- Absent distal pulses
- Overt distal ischemia
- Audible bruit
- Palpable thrill - Clinical Signs of Vascular Injury
Soft signs
- Significant hemorrhage found on history
- Decreased pulse compared to the contralateral extremity
- Bony injury or proximity to penetrating wound
- Neurologic abnormality - Arterial Injury: Patterns of Injury
- Hematoma
- Active extravasation
- Vasospasm
- Stenosis
- External compression
- Occlusion
- Intimal injury and dissection
- Arteriovenous fistulas
- Pseudoaneurysm formation - “ An advantage of 3D mapping is the ability to display the information in a format that not only simulates a classic catheter angiogram (digital subtraction), but also the capability to display tissue in addition to the vasculature,
including muscle, soft tissues, and bone. MIP
and VRT imaging may require segmentation with bone removal, especially when the extremities are involved. VRT is especially valuable when opaque foreign
matter is present.”
State of the art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (epub November 2012) - “A variety of factors may obscure or mimic vascular injury on MDCTA including inadequate arterial enhancement due to timing of the contrast injection, motion artifacts, inadequate positioning, streak artifacts, dense calcifications, and similar density of vessels and bone. Venous injuries may be missed on a single phase study or in the absence of late phase images.”
State of the art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls and pitfalls
Fritz J, Efron DT, Fishman EK
Emerg Radiol (epub November 2012)
- “ A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the ab- sence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients.”
Blunt Thoracic Trauma: An Analysis of 515 Patients
Shorr RM et al
Ann Surg Vol 206, No 2,pp 200-205 - “Sternal fracture is a common injury in a population where restraints are frequently used. Patients with an isolated sternal fracture do not require cardiac monitoring and those under 40 years of age may be cared for in a short stay ward.”
Sternal fractures: a retrospective analysis of 272 cases.
J Trauma 1993; 35(1):46-54
Brookes JG; Dunn RJ; Rogers IR - Sternal Fractures are Associated With
- Pulmonary contusion
- Retrosternal hematoma
- Pneumothorax
- Cardiac contusion (least common) - Vascular Trauma: CT Findings
Arterial injuries
- Pseudoaneurysm
- Active arterial hemorrhage
- AV fistulae
- Occlusion
- Intimal injury
- vasospasm
"Given the widespread availability as well as the ease of acquiring CTA in the trauma setting, CTA is increasingly being used as the initial diagnostic evaluation in extremity vascular trauma, replacing digital subtraction angiography in many institutions."
Extremity CT Angiography: Application to trauma using 64-MDCT
Sah N et al.
Emerg Radiol (2009) 16;425-432"The use of multiphasic images affords more definitive characterization of areas of "contrast blush" as to the underlying etiologies of contained vascular injuries or active hemorrhage."
CT of Blunt Abdominal and Pelvic Vascular Injury
Vi M et al.
Emerg Radiol (2010) 17;21-29- CT Angiography: Potential Limitations in Extremity Trauma
- Inadequate arterial enhancement
- Motion artifact
- Inadequate positioning
- Streak artifact "By demonstrating the extent, location, and type of injury, CT angiography aids in the decision making process to determine the appropriate management for each injury in each patient."
Use of 64-Row Multidetector CT Angiography in Blunt and Penetrating Trauma of the Upper and Lower Extremities
Pieroni S et al.
RadioGraphics 2009; 29:863-876"Sixty-four-row multidetector CT angiography of the extremities has the ability to demonstrate a variety of vascular injuries such as occlusion, pseudoaneurysm, active extravasation, and intimal dissection."
Use of 64-Row Multidetector CT Angiography in Blunt and Penetrating Trauma of the Upper and Lower Extremities
Pieroni S et al.
RadioGraphics 2009; 29:863-876- Vascular Injuries in Pelvic Fractures
- Active arterial extravasation
- Occlusion
- Intimal injury and occlusion
- Pseudoaneurysm
- Arterial dissection
- Arteriovenous fistulae
- Venous injury - Pelvic Fractures: Facts
- 40% of patients with pelvic fracture have a major bleed
- Overall mortality up to 15% in this population
- Death from hemorrhage usually in first 24 hours