Traumatic Arterial Injuries of the Extremities: Initial Evaluation with MDCT Angiography
Michael Rieger1,
Ammar Mallouhi2,
Thomas Tauscher3,
Martin Lutz4 and
Werner R. Jaschke1
1 Department of Radiology, Kurt Amplatz Center, Innsbruck University Hospital,
Innsbruck 6020, Austria.
2 Department of Radiology II, Innsbruck University Hospital, Anichstrasse 35,
Innsbruck 6020, Austria.
3 Department of Vascular Surgery, Innsbruck University Hospital, Innsbruck 6020,
Austria.
4 Department of Trauma Surgery, Innsbruck University Hospital, Innsbruck 6020,
Austria.
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Fig. 1 —66-year-old man with blunt trauma to left shoulder and dislocated
fracture of clavicle underwent MDCT angiography of shoulder and upper arm.
Coronal oblique reformatted MDCT angiogram of shoulder shows occlusion
(arrows) of left subclavian artery caused by dissection and
consequent thrombosis of involved arterial segment. Presence and extent of
dissection were indicated at digital subtraction angiography, and dissection
was successfully treated with stent implantation.
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Fig. 2 —19-year-old man with blunt trauma to right hand. Volume-rendered
MDCT hand angiogram shows occlusion of ulnar (arrows) and radial
proper palmar digital arteries of forefinger. Image also shows subcapital
fracture of proximal phalanx. Surgery confirmed presence of both occlusions
that were secondary to rupture of ulnar and dissection of radial digital
arteries.
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Fig. 3 —46-year-old man with blunt trauma to left foot. Volume-rendered MDCT
foot angiogram shows occlusion (arrow) of proximal segment of first
dorsal metatarsal artery associated with occlusion of second and third dorsal
metatarsal arteries and hypoperfusion of soft tissue at mediodorsal aspect of
forefoot. Surgery confirmed occlusion of three metatarsal arteries due to
compartment syndrome.
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Fig. 4A —18-year-old man with blunt trauma to right knee causing transient
posterior dislocation of knee joint, which was examined by MDCT angiography.
Transverse CT image shows severe eccentric stenosis (arrow) with
semilunar deformation (due to intramural hematoma) of popliteal artery lumen
at level of proximal third combined with occlusion (not shown) of middle and
distal thirds of popliteal artery.
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Fig. 4B —18-year-old man with blunt trauma to right knee causing transient
posterior dislocation of knee joint, which was examined by MDCT angiography.
Volume-rendered CT view shows eccentric stenosis (arrow) of proximal
third and occlusion of middle and distal thirds of popliteal artery. Surgery
confirmed presence of occlusion that was caused by arterial dissection.
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Fig. 5 —50-year-old man with trauma to right distal lower leg and ankle with
consequent complex injury of ankle, talocalcaneonavicular, and distal
radiofibular joints and distal fibula underwent MDCT angiography of foot and
distal lower leg. Oblique sagittal multiplanar reformation shows complete
obliteration (arrows) of anterior tibial artery indicating occlusion.
Image also shows concentric narrowings (arrowheads) of anterior
tibial artery indicating spasms. MDCT also revealed occlusion of distal
posterior tibial and fibular arteries (not shown). Surgery confirmed occlusion
of posterior tibial and fibular arteries due to dissection but revealed patent
anterior tibial artery indicating arterial spasm at time MDCT was
performed.
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Fig. 6 —16-year-old boy with blunt trauma to right upper leg with consequent
femur shaft fracture underwent MDCT angiography of knee. Volume-rendered MDCT
angiogram shows deviation and slight eccentric narrowing (arrow) of
lumen of popliteal artery at fracture level. At surgery, arterial deviation
and compression were confirmed.
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Fig. 7A —25-year-old man with blunt trauma to left upper leg with open
fracture of femur shaft and consequent diffuse bleeding and emphysema in soft
tissue underwent MDCT angiography of upper leg. Transverse CT image at
fracture level shows patency of superficial femoral artery (arrow)
and dislocated bone fragment (arrowhead).
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Fig. 7B —25-year-old man with blunt trauma to left upper leg with open
fracture of femur shaft and consequent diffuse bleeding and emphysema in soft
tissue underwent MDCT angiography of upper leg. Transverse CT image distal to
A shows segmental, concentric, smooth narrowing (arrow) of
superficial femoral artery indicating focal nonocclusive spasm. Image also
shows dislocated bone fragments (arrowheads). Surgery confirmed
patency of superficial femoral artery.
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Fig. 7C —25-year-old man with blunt trauma to left upper leg with open
fracture of femur shaft and consequent diffuse bleeding and emphysema in soft
tissue underwent MDCT angiography of upper leg. Volume-rendered MDCT angiogram
shows polysegmental, concentric, smooth narrowing (arrows) of
superficial femoral artery indicating focal nonocclusive spasm.
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Copyright © 2006 by the American Roentgen Ray Society.
