Emergent CT Angiography Research Articles

Rupture of a giant abdominal aortic aneurysm

We admitted a 76-year old male person with a ruptured abdominal aortic aneurysm. He was immediately brought to the emergency room (ER). The blood pressure was 80/40 mmHg, HTC less than 0.17. We decided to perform an emergent CT angiography wich verified referral diagnosis. The ruptured AAA was 12 cm in diameter. An emergent life saving operation had to be done so the patient was brought to the operation theatre (OT). The approach to the abdomen was a classic median laparotomy. After we had opened the abdomen, we found a huge retroperitoneal haematoma that pushed beside the intra-abdominal organs rising almost to the edge of the rectal fascia. The blood pressure suddenly dropped down to 45/25 mm Hg for the next several minutes. A continuous infusion of norepinephrine was administered (60 mcg/min) and we also administered several doses of pure adrenalin (3 mg) and pure norepinephrine (1 mg). We pulled out the intestines from the abdominal cavity and clamped the aorta just under the renal arteries. The blood pressure immediately rose to 80 mm Hg. Both common iliac arteries were clamped, too. During the surgery the patient was anuric. Autologous blood transfusion helped by cell saver was administered and additionally he got several doses of blood, blood derivates (fresh frozen plasma, cryoprecipitate, platelets) and other intravenous solutions at the amount of approximately eight litres. We replaced the ruptured AAA using 20 mm PTFE vascular graft. After surgery the patient was transferred to the intensive care unit (ICU) where the blood pressure rose and diuresis was established. First postoperative day the patient was woken up without neurological deficits. Second postoperative day the patient was able to expel the stool and he was transferred to the department of cardiovascular surgery. Tenth day after surgery he was discharged home. Six weeks after surgery we performed a control CT angiography that showed normal founding on the abdominal iliac and leg vessels.

ShouldAmerican Journal of NeuroradiologyCommentary Be Evidence-Based?

After the editorial alarmingly entitled “Death by Nondiagnosis: Why Emergent CT Angiography Should Not Be Done for Patients with Subarachnoid Hemorrhage”[1][1] in the American Journal of Neuroradiology ( AJNR ) in 2007, we were looking forward to an update in Dr Jayaraman's recent commentary

An 80-year-old man with acute onset of right upper limb weakness

An 80-year-old man with a history of hypertension was referred under the suspicion of stroke. He suffered from acute onset of right upper limb weakness 4 h before presenting to...

CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients

BackgroundPatients with acute stroke are often transferred to tertiary care centers for advanced interventional services. We hypothesized that the presence of a proximal cerebral artery occlusion on CT angiography (CTA) is an independent predictor of the use of these services.MethodsWe performed a historical cohort study of consecutive ischemic stroke patients presenting within 24 h of symptom onset to an academic emergency department who underwent emergent CTA. Use of tertiary care interventions including intra-arterial (IA) thrombolysis, mechanical clot retrieval, and neurosurgery were captured.ResultsDuring the study period, 207/290 (71%) of patients with acute ischemic stroke underwent emergent CTA. Of the patients, 74/207 (36%) showed evidence of a proximal cerebral artery occlusion, and 22/207 (11%) underwent an interventional procedure. Those with proximal occlusions were more likely to receive a neurointervention (26% vs. 2%, p < 0.001). They were more likely to undergo IA thrombolysis (9% vs. 0%, p = 0.001) or a mechanical intervention (19% vs. 0%, p < 0.0001), but not more likely to undergo neurosurgery (5% vs. 2%, p = 0.2). After controlling for the initial NIH stroke scale (NIHSS) score, proximal occlusion remained an independent predictor of the use of neurointerventional services (OR 8.5, 95% CI 2.2-33). Evidence of proximal occlusion on CTA predicted use of neurointervention with sensitivity of 82% (95% CI 59-94%), specificity of 71% (95% CI 64%-77%), positive predictive value (PPV) of 25% (95% CI 16%-37%), and negative predictive value (NPV) of 97% (95% CI 92%-99%).ConclusionProximal cerebral artery occlusion on CTA predicts the need for advanced neurointerventional services.

Aneurysmal Subarachnoid Hemorrhage: DSA versus CT Angiography—Is the Answer Available?

The only acceptable modality for imaging patients with intracranial aneurysms is that which detects the aneurysm quickly, reliably, and safely and guides the prompt proper therapy; in my experience, conventional angiography with digital subtraction angiography techniques usually comes closest to that ideal.

Discrepancy Rates of On-Call Radiology Residents' Interpretations of CT Angiography Studies of the Neck and Circle of Willis

The purpose of our study was to determine the discrepancy rates of radiology residents' interpretations of emergent CT angiography (CTA) studies of the neck and circle of Willis and to assess any adverse clinical outcomes. Five hundred thirty-eight CTA studies (287 circle of Willis and 251 neck) ordered emergently after hours and given preliminary readings by radiology residents from January 1, 2006, through December 31, 2007, were retrospectively reviewed. Discrepancies between the interpretations of radiology residents and the final reports of neuroradiology attending physicians were classified as either false-negatives (failure to recognize abnormalities) or false-positives (misinterpreting normal scans as abnormal). Discrepancies that could affect patient care or clinical care were considered major. Overall, the discrepancy rate was 13.6% for circle of Willis CTA and 13.5% for neck CTA. The misinterpretation rate of first-year residents was 19.5%, which was statistically significant compared with more senior-level residents (p = 0.05). There were 57 false-negative interpretations. The most common misses were stenosis greater than 50% (n = 16) and aneurysm (n = 15), and the most common false-positive was overcalling a potential intracranial aneurysm (n = 7). No adverse clinical outcomes were detected. The discrepancy rate between interpretations by on-call radiology residents and attending physicians of neuroradiology CTA studies was higher than expected at 13.6%, with a statistically significant greater miss rate among the most junior residents, which may be mitigated by recent changes with respect to the radiology residents' overnight call. No adverse clinical outcome was detected.

Life at the End of the Tunnel: Why Emergent CT Angiography Should Be Done for Patients With Acute Subarachnoid Hemorrhage

We read with interest the provocative recent editorial by Kallmes et al[1][1] condemning the use of CT angiography (CTA) in the work-up of patients with acute subarachnoid hemorrhage (SAH). We feel compelled to express our disagreement. Our experience with CTA as a first-line screening technique in

Death by Nondiagnosis: Why Emergent CT Angiography Should Not Be Done for Patients with Subarachnoid Hemorrhage

We read with great interest the recent editorial in this journal by Kallmes et al[1][1] about CT angiography (CTA) in patients with subarachnoid hemorrhage (SAH). As can be expected in an editorial, the content is provocative because the authors state that conventional angiography is the one and

Death by Nondiagnosis: Why Emergent CT Angiography Should Not Be Done for Patients with Subarachnoid Hemorrhage

As angiographers, we often feel stabs of inadequacy when first reading the many articles promoting the use of CT angiography (CTA) for aneurysm detection. On the basis of the apparently outstanding accuracy of the technique, many centers routinely apply CTA for evaluating patients presenting with

An unusual case of pulmonary embolism after arthroscopic meniscectomy

Although the incidence of pulmonary embolism (PE) following arthroscopic knee surgery has not been well established, such occurrences place the patient at high risk. In this report we present a case of PE following arthroscopic meniscectomy. The patient was a 63-year-old woman, with no definite risk factors for PE, who underwent successful arthroscopic meniscectomy. However, on the postoperative 9th day she developed dyspnea and tachycardia. Investigations carried out in the emergency department, including EKG, echocardiography, and CT angiography, supported the diagnosis of a PE. Heparin therapy was initiated, and the patient's condition then improved sufficiently to allow follow-up at our outpatient department.