1
|
Gopireddy DR, Kee-Sampson JW, Vulasala SSR, Stein R, Kumar S, Virarkar M. Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds. J Clin Imaging Sci 2023; 13:1. [PMID: 36751564 PMCID: PMC9899476 DOI: 10.25259/jcis_99_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.
Collapse
Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Joanna W. Kee-Sampson
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sai Swarupa Reddy Vulasala
- Department of Internal Medicine, East Carolina University Health Medical Center, Greenville, North Carolina, United States
| | - Rachel Stein
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| |
Collapse
|
2
|
Current Concepts in Imaging Diagnosis and Screening of Blunt Cerebrovascular Injuries. Tomography 2022; 8:402-413. [PMID: 35202198 PMCID: PMC8877014 DOI: 10.3390/tomography8010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 11/21/2022] Open
Abstract
Blunt cerebrovascular injury (BCVI) is an often underrecognized injury occurring in the carotid or vertebral arteries, associated with a risk of ischemic stroke and potential for poor neurological outcome or death. Computed tomographic angiography (CTA) is the most common modality for initial screening and diagnosis. Vessel wall intimal injuries, intraluminal thrombus, dissection, intramural hematoma, pseudoaneurysm, vessel transection, and arteriovenous fistula, are potential findings to be considered in approach to imaging. Identification of high-risk trauma patients based on clinical and radiological risk factors can determine patients at risk of BCVI for targeted screening.
Collapse
|
3
|
Chapman SC, McDaniel B, Andraska E, Phillips A, Madigan MC. CT Three-Dimensional (3D) Modeling Maintains Fluoroscopy Time and Contrast Volume to a Minimum in the Endovascular Treatment of Great Vessel Injury from Iatrogenic Trauma. Ann Vasc Surg 2020; 65:283.e13-283.e17. [DOI: 10.1016/j.avsg.2019.10.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
|
4
|
Bodanapally UK, Sliker CW. Imaging of Blunt and Penetrating Craniocervical Arterial Injuries. Semin Roentgenol 2016; 51:152-64. [DOI: 10.1053/j.ro.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
5
|
Abstract
OBJECTIVE We will review the common injuries and anatomic distributions of blunt cerebrovascular injuries (BCVIs) of the neck, explain the grading criteria, and discuss the corresponding management. Artifacts associated with BCVI on CT will also be examined. CONCLUSION Identifying common injury patterns and anatomic distributions associated with BCVI can help decide the grade and management earlier and reduce the risk for potential complications. Recognizing the common artifacts associated with BCVI helps the reader successfully recognize a true BCVI.
Collapse
|
6
|
Liang T, Plaa N, Tashakkor AY, Nicolaou S. Imaging of Blunt Cerebrovascular Injuries. Semin Roentgenol 2012; 47:306-19. [DOI: 10.1053/j.ro.2012.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
7
|
Munera F, Danton G, Rivas LA, Henry RP, Ferrari MG. Multidetector row computed tomography in the management of penetrating neck injuries. Semin Ultrasound CT MR 2009; 30:195-204. [PMID: 19537052 DOI: 10.1053/j.sult.2009.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Penetrating neck trauma may occur from gun shots, stabbings, and accidental injury. Approximately 50% of gunshot and 10%-20% of stab-wound patients are reported as having severe injuries and the mortality from severe vascular injuries is reported as high as 50%. Penetrating traumatic neck injury is no longer best managed with exploratory surgery or conventional angiography in the stable patient. Computed tomography angiography has proven to be a useful, safe, and reliable means of diagnosis. Experience with interpreting and reconstructing computed tomography images, understanding the clinically important findings, and avoiding pitfalls is critical for successful patient care. Therefore, radiologists and clinicians who treat trauma patients need to familiarize themselves with the computed tomography angiography technique and appearances of vascular injury and know when to recommend further evaluation, such as interventional angiography or open surgery.
Collapse
Affiliation(s)
- Felipe Munera
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami, Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136, USA.
| | | | | | | | | |
Collapse
|
8
|
Abstract
A patient with an axillary artery gunshot wound pseudoaneurysm was evaluated and managed with computed tomographic angiogram and endovascular stent graft. Vascular injuries resulting from penetrating trauma or interventional vascular procedures are relatively uncommon. Subclavian and axillary arterial injuries may be associated with substantial morbidity and mortality if not managed expeditiously. The inaccessibility of these arteries makes stent graft treatment particularly attractive. The stable patient with a pseudoaneurysm or an arteriovenous fistula seems to be the ideal candidate to treat in this way. As computed tomography (CT) technology has evolved, CT angiography has become an integral part of the initial assessment of proximal extremity vascular injuries.
Collapse
|
9
|
Sliker CW. Blunt Cerebrovascular Injuries: Imaging with Multidetector CT Angiography. Radiographics 2008; 28:1689-708; discussion 1709-10. [DOI: 10.1148/rg.286085521] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
10
|
Degiannis E, Bowley DM, Bode F, Lynn WR, Glapa M, Baxter S, Shapey J, Smith MD, Doll D. Ballistic Arterial Trauma to the Lower Extremity: Recent South African Experience. Am Surg 2007. [DOI: 10.1177/000313480707301112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the current outcome of gunshots to the arteries of the lower extremity. The authors conducted a retrospective analysis of 104 patients with gunshots to the femoral (n = 71) and popliteal (n = 33) artery. One hundred four patients presented over the 60-month period. Ninety-six (92%) were male and eight of 104 female. Ninety-nine were gunshot injuries, five from shotguns. Nine patients had injury to the common femoral artery, 62 patients had injury to the superficial femoral artery, and 33 had popliteal artery injury. One patient died in the emergency room and another died in the postoperative period, giving an overall in-hospital mortality of two of 104 (1.9%). Forty-three of 70 femoral reconstructions had completion angiograms compared with 20 of 32 popliteal artery reconstructions ( P = 1). Nineteen of 63 (30%) of the completion angiograms prompted revision of the reconstruction. Of the 63 patients who had completion angiograms, two of 63 (3%) required amputation. Seven of 39 (18%) patients who did not have completion angiograms required amputation ( P = 0.025). Including the primary amputation, there were 10 amputations in the 103 patients (9.7%) who survived to undergo operation. Ballistic arterial trauma of the lower limb leads to significant disability. Completion arteriography leads to revision of the reconstruction in nearly one-third of instances and significantly reduces amputation rate.
Collapse
Affiliation(s)
- Elias Degiannis
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Douglas M. Bowley
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Frank Bode
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - William R. Lynn
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Miriam Glapa
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Shaun Baxter
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - James Shapey
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Martin D. Smith
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Dietrich Doll
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| |
Collapse
|
11
|
Brasel KJ, Pham K, Yang H, Christensen R, Weigelt JA. Significance of contrast extravasation in patients with pelvic fracture. ACTA ACUST UNITED AC 2007; 62:1149-52. [PMID: 17495715 DOI: 10.1097/ta.0b013e3180479827] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contained contrast extravasation (CE) in solid organ injury is not well correlated with the need for operative intervention, but the significance of CE in patients with pelvic fracture is unknown. METHODS The trauma registry at a Level I trauma center was queried for all patients with pelvic fracture from January 1, 1998 to May 31, 2005. All computed tomography (CT) scans used helical technology. Demographic and injury information were abstracted from the trauma registry and medical record. CT and angiography reports of all patients were reviewed. Angiograms and abdominal and pelvic CT studies (AP-CT) of patients with CE were then reviewed by a radiologist. RESULTS A total of 604 patients with a pelvic fracture and an AP-CT were identified. Of these, 42 patients had a pelvic CE on CT study. Patients with CE had a higher Injury Severity Score (24.5 vs. 18.3, p<0.001) and higher mortality (24 vs. 6%, p<0.001). Twenty-five patients with CE underwent angiography, with CE confirmed in 19 patients and embolization performed in 17. Six patients without CE underwent angiography. CE was confirmed in two patients and both were embolized. A significantly higher number of patients undergoing angiography required ongoing transfusion. CONCLUSIONS CE is a marker of severe injury but does not mandate angiography. Associated injuries are common and other sources of blood loss must be excluded. CE is not reliable enough to exclude significant vascular injury, as the therapeutic embolization rate for CE-negative patients undergoing angiography is 33%.
Collapse
Affiliation(s)
- Karen J Brasel
- Department of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
| | | | | | | | | |
Collapse
|
12
|
Imaging and Intervention of Large Arterial Trauma. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Ersel M, Kiyan S, Aksay E, Eygi B, Calkavur T. Axillary artery dissection due to blunt shoulder trauma. Am J Emerg Med 2007; 25:242-3. [PMID: 17276837 DOI: 10.1016/j.ajem.2006.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 11/02/2006] [Indexed: 11/17/2022] Open
Affiliation(s)
- Murat Ersel
- Department of Emergency Medicine, Ege University Hospital, Bornova IZMIR, Turkey.
| | | | | | | | | |
Collapse
|