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Vascular Emergencies of the Thorax after Blunt and Iatrogenic Trauma: Multi–Detector Row CT and Three-dimensional Imaging¹

¹ From the Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland (H.A., S.W., L.D., T.S., D.C., B.M.); and the Department of Radiology, Kantonsspital, Loestrasse 170, 7000 Chur, Switzerland (T.B.). Received October 30, 2003; revision requested January 5, 2004, and received February 23; accepted March 8. Supported by the NCCR CO-ME of the Swiss National Science Foundation. All authors have no financial relationships to disclose. Address correspondence to T.B. (e-mail: thomas_boehm@gmx.net).

View larger version (102K): [in a new window]   Figure 1a.  Incomplete rupture of the descending aorta in a 51-year-old man with blunt thoracic trauma from a traffic accident. (a, b) Axial CT image (a) and oblique sagittal reformatted image (b) show a saccular outpouching of the descending aorta. The outpouching is demarcated from the aortic lumen by a collar (arrowheads), and there is only a small periaortic hematoma. The nasogastric tube is not deviated. (c) Sagittal volume rendered image shows the pseudoaneurysm more clearly. (d) Left anterior oblique angiogram shows endovascular repair of the aneurysm. (e) Left anterior oblique angiogram shows that the repair was successful, with preservation of all supraaortic vessels.

View larger version (162K): [in a new window]   Figure 1b.  Incomplete rupture of the descending aorta in a 51-year-old man with blunt thoracic trauma from a traffic accident. (a, b) Axial CT image (a) and oblique sagittal reformatted image (b) show a saccular outpouching of the descending aorta. The outpouching is demarcated from the aortic lumen by a collar (arrowheads), and there is only a small periaortic hematoma. The nasogastric tube is not deviated. (c) Sagittal volume rendered image shows the pseudoaneurysm more clearly. (d) Left anterior oblique angiogram shows endovascular repair of the aneurysm. (e) Left anterior oblique angiogram shows that the repair was successful, with preservation of all supraaortic vessels.

View larger version (168K): [in a new window]   Figure 1c.  Incomplete rupture of the descending aorta in a 51-year-old man with blunt thoracic trauma from a traffic accident. (a, b) Axial CT image (a) and oblique sagittal reformatted image (b) show a saccular outpouching of the descending aorta. The outpouching is demarcated from the aortic lumen by a collar (arrowheads), and there is only a small periaortic hematoma. The nasogastric tube is not deviated. (c) Sagittal volume rendered image shows the pseudoaneurysm more clearly. (d) Left anterior oblique angiogram shows endovascular repair of the aneurysm. (e) Left anterior oblique angiogram shows that the repair was successful, with preservation of all supraaortic vessels.

View larger version (139K): [in a new window]   Figure 1d.  Incomplete rupture of the descending aorta in a 51-year-old man with blunt thoracic trauma from a traffic accident. (a, b) Axial CT image (a) and oblique sagittal reformatted image (b) show a saccular outpouching of the descending aorta. The outpouching is demarcated from the aortic lumen by a collar (arrowheads), and there is only a small periaortic hematoma. The nasogastric tube is not deviated. (c) Sagittal volume rendered image shows the pseudoaneurysm more clearly. (d) Left anterior oblique angiogram shows endovascular repair of the aneurysm. (e) Left anterior oblique angiogram shows that the repair was successful, with preservation of all supraaortic vessels.

View larger version (108K): [in a new window]   Figure 1e.  Incomplete rupture of the descending aorta in a 51-year-old man with blunt thoracic trauma from a traffic accident. (a, b) Axial CT image (a) and oblique sagittal reformatted image (b) show a saccular outpouching of the descending aorta. The outpouching is demarcated from the aortic lumen by a collar (arrowheads), and there is only a small periaortic hematoma. The nasogastric tube is not deviated. (c) Sagittal volume rendered image shows the pseudoaneurysm more clearly. (d) Left anterior oblique angiogram shows endovascular repair of the aneurysm. (e) Left anterior oblique angiogram shows that the repair was successful, with preservation of all supraaortic vessels.

View larger version (126K): [in a new window]   Figure 2a.  Complete aortic rupture in a 48-year-old woman with blunt thoracic trauma from a skydiving accident. The lesion was successfully repaired at surgery; however, the patient subsequently died due to severe brain injury. (a) Anteroposterior chest radiograph shows a widened upper mediastinum with a faint left apical extrapleural cap (arrows). (b) Axial CT image of the aortic isthmus shows complete transection of the aortic wall (arrowheads) with a periaortic hematoma and hemomediastinum. (c) Sagittal thin-slab MIP image shows a second, more caudal site of aortic transection (arrowhead) and active mediastinal bleeding. Note the common origin of the brachiocephalic trunk and the left common carotid artery. (d, e) Sagittal volume rendered image (d) and oblique shaded surface display image (e) show both sites of aortic transection (arrowheads) and blood extravasation, thereby facilitating surgical or endovascular intervention.

View larger version (108K): [in a new window]   Figure 2b.  Complete aortic rupture in a 48-year-old woman with blunt thoracic trauma from a skydiving accident. The lesion was successfully repaired at surgery; however, the patient subsequently died due to severe brain injury. (a) Anteroposterior chest radiograph shows a widened upper mediastinum with a faint left apical extrapleural cap (arrows). (b) Axial CT image of the aortic isthmus shows complete transection of the aortic wall (arrowheads) with a periaortic hematoma and hemomediastinum. (c) Sagittal thin-slab MIP image shows a second, more caudal site of aortic transection (arrowhead) and active mediastinal bleeding. Note the common origin of the brachiocephalic trunk and the left common carotid artery. (d, e) Sagittal volume rendered image (d) and oblique shaded surface display image (e) show both sites of aortic transection (arrowheads) and blood extravasation, thereby facilitating surgical or endovascular intervention.

View larger version (141K): [in a new window]   Figure 2c.  Complete aortic rupture in a 48-year-old woman with blunt thoracic trauma from a skydiving accident. The lesion was successfully repaired at surgery; however, the patient subsequently died due to severe brain injury. (a) Anteroposterior chest radiograph shows a widened upper mediastinum with a faint left apical extrapleural cap (arrows). (b) Axial CT image of the aortic isthmus shows complete transection of the aortic wall (arrowheads) with a periaortic hematoma and hemomediastinum. (c) Sagittal thin-slab MIP image shows a second, more caudal site of aortic transection (arrowhead) and active mediastinal bleeding. Note the common origin of the brachiocephalic trunk and the left common carotid artery. (d, e) Sagittal volume rendered image (d) and oblique shaded surface display image (e) show both sites of aortic transection (arrowheads) and blood extravasation, thereby facilitating surgical or endovascular intervention.

View larger version (156K): [in a new window]   Figure 2d.  Complete aortic rupture in a 48-year-old woman with blunt thoracic trauma from a skydiving accident. The lesion was successfully repaired at surgery; however, the patient subsequently died due to severe brain injury. (a) Anteroposterior chest radiograph shows a widened upper mediastinum with a faint left apical extrapleural cap (arrows). (b) Axial CT image of the aortic isthmus shows complete transection of the aortic wall (arrowheads) with a periaortic hematoma and hemomediastinum. (c) Sagittal thin-slab MIP image shows a second, more caudal site of aortic transection (arrowhead) and active mediastinal bleeding. Note the common origin of the brachiocephalic trunk and the left common carotid artery. (d, e) Sagittal volume rendered image (d) and oblique shaded surface display image (e) show both sites of aortic transection (arrowheads) and blood extravasation, thereby facilitating surgical or endovascular intervention.

View larger version (98K): [in a new window]   Figure 2e.  Complete aortic rupture in a 48-year-old woman with blunt thoracic trauma from a skydiving accident. The lesion was successfully repaired at surgery; however, the patient subsequently died due to severe brain injury. (a) Anteroposterior chest radiograph shows a widened upper mediastinum with a faint left apical extrapleural cap (arrows). (b) Axial CT image of the aortic isthmus shows complete transection of the aortic wall (arrowheads) with a periaortic hematoma and hemomediastinum. (c) Sagittal thin-slab MIP image shows a second, more caudal site of aortic transection (arrowhead) and active mediastinal bleeding. Note the common origin of the brachiocephalic trunk and the left common carotid artery. (d, e) Sagittal volume rendered image (d) and oblique shaded surface display image (e) show both sites of aortic transection (arrowheads) and blood extravasation, thereby facilitating surgical or endovascular intervention.

View larger version (125K): [in a new window]   Figure 3a.  Complex aortic dissection and bilateral hemothorax in a 44-year-old woman with blunt thoracic trauma from a motorcycle accident. (a) Axial CT image of the aortic arch shows the intimomedial flap, which divides the aorta into true (T) and false (F) lumina. (b) Axial CT image of the aortic arch shows the intimal entrance tear (arrow). (c, d) Oblique thin-slab MIP images show the origin of the dissection and its extension to the left common carotid artery (arrow in c) and the brachiocephalic trunk (arrowhead in d).

View larger version (125K): [in a new window]   Figure 3b.  Complex aortic dissection and bilateral hemothorax in a 44-year-old woman with blunt thoracic trauma from a motorcycle accident. (a) Axial CT image of the aortic arch shows the intimomedial flap, which divides the aorta into true (T) and false (F) lumina. (b) Axial CT image of the aortic arch shows the intimal entrance tear (arrow). (c, d) Oblique thin-slab MIP images show the origin of the dissection and its extension to the left common carotid artery (arrow in c) and the brachiocephalic trunk (arrowhead in d).

View larger version (155K): [in a new window]   Figure 3c.  Complex aortic dissection and bilateral hemothorax in a 44-year-old woman with blunt thoracic trauma from a motorcycle accident. (a) Axial CT image of the aortic arch shows the intimomedial flap, which divides the aorta into true (T) and false (F) lumina. (b) Axial CT image of the aortic arch shows the intimal entrance tear (arrow). (c, d) Oblique thin-slab MIP images show the origin of the dissection and its extension to the left common carotid artery (arrow in c) and the brachiocephalic trunk (arrowhead in d).

View larger version (169K): [in a new window]   Figure 3d.  Complex aortic dissection and bilateral hemothorax in a 44-year-old woman with blunt thoracic trauma from a motorcycle accident. (a) Axial CT image of the aortic arch shows the intimomedial flap, which divides the aorta into true (T) and false (F) lumina. (b) Axial CT image of the aortic arch shows the intimal entrance tear (arrow). (c, d) Oblique thin-slab MIP images show the origin of the dissection and its extension to the left common carotid artery (arrow in c) and the brachiocephalic trunk (arrowhead in d).

View larger version (110K): [in a new window]   Figure 4a.  (a-c) Arterial dissection after minor thoracic trauma in a 23-year-old patient with type IV Ehlers-Danlos syndrome. (a) Axial CT image of the origin of the left subclavian artery shows an intimomedial flap, which divides the artery into true (T) and false (F) lumina. (b) Axial CT image shows a crescent-shaped intramural hematoma (arrowheads) surrounding the true lumen. (c) Sagittal volume rendered image shows a dissection of the proximal descending aorta (type B dissection) (arrow). The dissection extends into the origin of the left subclavian artery. (d, e) Arterial rupture after minor thoracic trauma in a 19-year-old patient with type IV Ehlers-Danlos syndrome. (d) Coronal thin-slab MIP image shows a ruptured aneurysm of the left subclavian artery (arrow), which caused left-sided hemothorax. There is also a nonruptured, partially calcified aneurysm of the right subclavian artery. This aneurysm was asymptomatic and was probably chronic. (e) Oblique coronal volume rendered image from the arterial phase includes only the arterial vessels and thus shows the aneurysms more clearly.

View larger version (121K): [in a new window]   Figure 4b.  (a-c) Arterial dissection after minor thoracic trauma in a 23-year-old patient with type IV Ehlers-Danlos syndrome. (a) Axial CT image of the origin of the left subclavian artery shows an intimomedial flap, which divides the artery into true (T) and false (F) lumina. (b) Axial CT image shows a crescent-shaped intramural hematoma (arrowheads) surrounding the true lumen. (c) Sagittal volume rendered image shows a dissection of the proximal descending aorta (type B dissection) (arrow). The dissection extends into the origin of the left subclavian artery. (d, e) Arterial rupture after minor thoracic trauma in a 19-year-old patient with type IV Ehlers-Danlos syndrome. (d) Coronal thin-slab MIP image shows a ruptured aneurysm of the left subclavian artery (arrow), which caused left-sided hemothorax. There is also a nonruptured, partially calcified aneurysm of the right subclavian artery. This aneurysm was asymptomatic and was probably chronic. (e) Oblique coronal volume rendered image from the arterial phase includes only the arterial vessels and thus shows the aneurysms more clearly.

View larger version (148K): [in a new window]   Figure 4c.  (a-c) Arterial dissection after minor thoracic trauma in a 23-year-old patient with type IV Ehlers-Danlos syndrome. (a) Axial CT image of the origin of the left subclavian artery shows an intimomedial flap, which divides the artery into true (T) and false (F) lumina. (b) Axial CT image shows a crescent-shaped intramural hematoma (arrowheads) surrounding the true lumen. (c) Sagittal volume rendered image shows a dissection of the proximal descending aorta (type B dissection) (arrow). The dissection extends into the origin of the left subclavian artery. (d, e) Arterial rupture after minor thoracic trauma in a 19-year-old patient with type IV Ehlers-Danlos syndrome. (d) Coronal thin-slab MIP image shows a ruptured aneurysm of the left subclavian artery (arrow), which caused left-sided hemothorax. There is also a nonruptured, partially calcified aneurysm of the right subclavian artery. This aneurysm was asymptomatic and was probably chronic. (e) Oblique coronal volume rendered image from the arterial phase includes only the arterial vessels and thus shows the aneurysms more clearly.

View larger version (145K): [in a new window]   Figure 4d.  (a-c) Arterial dissection after minor thoracic trauma in a 23-year-old patient with type IV Ehlers-Danlos syndrome. (a) Axial CT image of the origin of the left subclavian artery shows an intimomedial flap, which divides the artery into true (T) and false (F) lumina. (b) Axial CT image shows a crescent-shaped intramural hematoma (arrowheads) surrounding the true lumen. (c) Sagittal volume rendered image shows a dissection of the proximal descending aorta (type B dissection) (arrow). The dissection extends into the origin of the left subclavian artery. (d, e) Arterial rupture after minor thoracic trauma in a 19-year-old patient with type IV Ehlers-Danlos syndrome. (d) Coronal thin-slab MIP image shows a ruptured aneurysm of the left subclavian artery (arrow), which caused left-sided hemothorax. There is also a nonruptured, partially calcified aneurysm of the right subclavian artery. This aneurysm was asymptomatic and was probably chronic. (e) Oblique coronal volume rendered image from the arterial phase includes only the arterial vessels and thus shows the aneurysms more clearly.

View larger version (181K): [in a new window]   Figure 4e.  (a-c) Arterial dissection after minor thoracic trauma in a 23-year-old patient with type IV Ehlers-Danlos syndrome. (a) Axial CT image of the origin of the left subclavian artery shows an intimomedial flap, which divides the artery into true (T) and false (F) lumina. (b) Axial CT image shows a crescent-shaped intramural hematoma (arrowheads) surrounding the true lumen. (c) Sagittal volume rendered image shows a dissection of the proximal descending aorta (type B dissection) (arrow). The dissection extends into the origin of the left subclavian artery. (d, e) Arterial rupture after minor thoracic trauma in a 19-year-old patient with type IV Ehlers-Danlos syndrome. (d) Coronal thin-slab MIP image shows a ruptured aneurysm of the left subclavian artery (arrow), which caused left-sided hemothorax. There is also a nonruptured, partially calcified aneurysm of the right subclavian artery. This aneurysm was asymptomatic and was probably chronic. (e) Oblique coronal volume rendered image from the arterial phase includes only the arterial vessels and thus shows the aneurysms more clearly.

View larger version (82K): [in a new window]   Figure 5a.  Acute intramural hematoma of the aorta in a 45-year-old man with blunt thoracic trauma from a traffic accident. (a) Axial CT image shows a small, linear, hypoattenuating lesion along the left wall of the aortic arch (arrowheads). This lesion represents an acute intramural hematoma. (b) Magnified coronal reformatted image shows the hematoma, which is crescent shaped. The hematoma extends over nearly half of the circumference of the left aortic wall (arrowheads) with minimal eccentric narrowing of the lumen. (c) Magnified sagittal reformatted image of the origin of the left subclavian artery shows cranial extension of the hematoma into the wall of the artery. (d) Transesophageal echocardiogram shows the extent of the hematoma (arrow), which extends into the proximal descending aorta. (Fig 5d courtesy of R. Jenni, MD, University Hospital Zurich, Switzerland.)

View larger version (108K): [in a new window]   Figure 5b.  Acute intramural hematoma of the aorta in a 45-year-old man with blunt thoracic trauma from a traffic accident. (a) Axial CT image shows a small, linear, hypoattenuating lesion along the left wall of the aortic arch (arrowheads). This lesion represents an acute intramural hematoma. (b) Magnified coronal reformatted image shows the hematoma, which is crescent shaped. The hematoma extends over nearly half of the circumference of the left aortic wall (arrowheads) with minimal eccentric narrowing of the lumen. (c) Magnified sagittal reformatted image of the origin of the left subclavian artery shows cranial extension of the hematoma into the wall of the artery. (d) Transesophageal echocardiogram shows the extent of the hematoma (arrow), which extends into the proximal descending aorta. (Fig 5d courtesy of R. Jenni, MD, University Hospital Zurich, Switzerland.)

View larger version (131K): [in a new window]   Figure 5c.  Acute intramural hematoma of the aorta in a 45-year-old man with blunt thoracic trauma from a traffic accident. (a) Axial CT image shows a small, linear, hypoattenuating lesion along the left wall of the aortic arch (arrowheads). This lesion represents an acute intramural hematoma. (b) Magnified coronal reformatted image shows the hematoma, which is crescent shaped. The hematoma extends over nearly half of the circumference of the left aortic wall (arrowheads) with minimal eccentric narrowing of the lumen. (c) Magnified sagittal reformatted image of the origin of the left subclavian artery shows cranial extension of the hematoma into the wall of the artery. (d) Transesophageal echocardiogram shows the extent of the hematoma (arrow), which extends into the proximal descending aorta. (Fig 5d courtesy of R. Jenni, MD, University Hospital Zurich, Switzerland.)

View larger version (64K): [in a new window]   Figure 5d.  Acute intramural hematoma of the aorta in a 45-year-old man with blunt thoracic trauma from a traffic accident. (a) Axial CT image shows a small, linear, hypoattenuating lesion along the left wall of the aortic arch (arrowheads). This lesion represents an acute intramural hematoma. (b) Magnified coronal reformatted image shows the hematoma, which is crescent shaped. The hematoma extends over nearly half of the circumference of the left aortic wall (arrowheads) with minimal eccentric narrowing of the lumen. (c) Magnified sagittal reformatted image of the origin of the left subclavian artery shows cranial extension of the hematoma into the wall of the artery. (d) Transesophageal echocardiogram shows the extent of the hematoma (arrow), which extends into the proximal descending aorta. (Fig 5d courtesy of R. Jenni, MD, University Hospital Zurich, Switzerland.)

View larger version (111K): [in a new window]   Figure 6a.  Pseudoaneurysm of the ascending aorta 2 weeks after endovascular repair of a descending aortic aneurysm in a 78-year-old man with severe arteriosclerosis. (a) Anteroposterior angiogram obtained at the time of the endovascular procedure shows no pseudoaneurysm. (b) Axial thin-slab MIP image shows a partially thrombosed pseudoaneurysm originating from the ascending aorta (arrow). (c) Coronal thin-slab MIP image shows the pseudoaneurysm as a saccular outpouching, which is demarcated from the aortic lumen by a collar (arrowheads). (d) Sagittal volume rendered image shows severe arteriosclerosis, a stent-graft in the descending aorta, and the perfused region of the pseudoaneurysm (arrow).

View larger version (116K): [in a new window]   Figure 6b.  Pseudoaneurysm of the ascending aorta 2 weeks after endovascular repair of a descending aortic aneurysm in a 78-year-old man with severe arteriosclerosis. (a) Anteroposterior angiogram obtained at the time of the endovascular procedure shows no pseudoaneurysm. (b) Axial thin-slab MIP image shows a partially thrombosed pseudoaneurysm originating from the ascending aorta (arrow). (c) Coronal thin-slab MIP image shows the pseudoaneurysm as a saccular outpouching, which is demarcated from the aortic lumen by a collar (arrowheads). (d) Sagittal volume rendered image shows severe arteriosclerosis, a stent-graft in the descending aorta, and the perfused region of the pseudoaneurysm (arrow).

View larger version (127K): [in a new window]   Figure 6c.  Pseudoaneurysm of the ascending aorta 2 weeks after endovascular repair of a descending aortic aneurysm in a 78-year-old man with severe arteriosclerosis. (a) Anteroposterior angiogram obtained at the time of the endovascular procedure shows no pseudoaneurysm. (b) Axial thin-slab MIP image shows a partially thrombosed pseudoaneurysm originating from the ascending aorta (arrow). (c) Coronal thin-slab MIP image shows the pseudoaneurysm as a saccular outpouching, which is demarcated from the aortic lumen by a collar (arrowheads). (d) Sagittal volume rendered image shows severe arteriosclerosis, a stent-graft in the descending aorta, and the perfused region of the pseudoaneurysm (arrow).

View larger version (174K): [in a new window]   Figure 6d.  Pseudoaneurysm of the ascending aorta 2 weeks after endovascular repair of a descending aortic aneurysm in a 78-year-old man with severe arteriosclerosis. (a) Anteroposterior angiogram obtained at the time of the endovascular procedure shows no pseudoaneurysm. (b) Axial thin-slab MIP image shows a partially thrombosed pseudoaneurysm originating from the ascending aorta (arrow). (c) Coronal thin-slab MIP image shows the pseudoaneurysm as a saccular outpouching, which is demarcated from the aortic lumen by a collar (arrowheads). (d) Sagittal volume rendered image shows severe arteriosclerosis, a stent-graft in the descending aorta, and the perfused region of the pseudoaneurysm (arrow).

View larger version (136K): [in a new window]   Figure 7a.  Catheter injury in a 58-year-old woman with hemoptysis after aortic valve replacement followed by placement of a Swan-Ganz catheter. (a) Axial CT image shows a pseudoaneurysm of a right pulmonary vessel. The pseudoaneurysm is contained by consolidated lung parenchyma. (b, c) Coronal thin-slab MIP (b) and coronal volume rendered (c) images show the feeding artery at the inferomedial border of the pseudoaneurysm (arrowhead). (d) Anteroposterior angiogram obtained with superselective injection of contrast medium shows the pseudoaneurysm and its feeding artery. The pseudoaneurysm was successfully treated with coil embolization.

View larger version (112K): [in a new window]   Figure 7b.  Catheter injury in a 58-year-old woman with hemoptysis after aortic valve replacement followed by placement of a Swan-Ganz catheter. (a) Axial CT image shows a pseudoaneurysm of a right pulmonary vessel. The pseudoaneurysm is contained by consolidated lung parenchyma. (b, c) Coronal thin-slab MIP (b) and coronal volume rendered (c) images show the feeding artery at the inferomedial border of the pseudoaneurysm (arrowhead). (d) Anteroposterior angiogram obtained with superselective injection of contrast medium shows the pseudoaneurysm and its feeding artery. The pseudoaneurysm was successfully treated with coil embolization.

View larger version (166K): [in a new window]   Figure 7c.  Catheter injury in a 58-year-old woman with hemoptysis after aortic valve replacement followed by placement of a Swan-Ganz catheter. (a) Axial CT image shows a pseudoaneurysm of a right pulmonary vessel. The pseudoaneurysm is contained by consolidated lung parenchyma. (b, c) Coronal thin-slab MIP (b) and coronal volume rendered (c) images show the feeding artery at the inferomedial border of the pseudoaneurysm (arrowhead). (d) Anteroposterior angiogram obtained with superselective injection of contrast medium shows the pseudoaneurysm and its feeding artery. The pseudoaneurysm was successfully treated with coil embolization.

View larger version (118K): [in a new window]   Figure 7d.  Catheter injury in a 58-year-old woman with hemoptysis after aortic valve replacement followed by placement of a Swan-Ganz catheter. (a) Axial CT image shows a pseudoaneurysm of a right pulmonary vessel. The pseudoaneurysm is contained by consolidated lung parenchyma. (b, c) Coronal thin-slab MIP (b) and coronal volume rendered (c) images show the feeding artery at the inferomedial border of the pseudoaneurysm (arrowhead). (d) Anteroposterior angiogram obtained with superselective injection of contrast medium shows the pseudoaneurysm and its feeding artery. The pseudoaneurysm was successfully treated with coil embolization.

View larger version (128K): [in a new window]   Figure 8a.  Hemopericardium in a 23-year-old man with non-Hodgkin lymphoma who experienced acute retrosternal pain and dyspnea after central venous cannulation. (a, b) Axial CT images show hemopericardium (arrow in a) and small collections of extraluminal air ventral to the distal superior vena cava (arrowhead in b). These findings suggest that a perforation has occurred. (c) Coronal thin-slab MIP image shows the location of the central venous catheter after correction of the complication.

View larger version (118K): [in a new window]   Figure 8b.  Hemopericardium in a 23-year-old man with non-Hodgkin lymphoma who experienced acute retrosternal pain and dyspnea after central venous cannulation. (a, b) Axial CT images show hemopericardium (arrow in a) and small collections of extraluminal air ventral to the distal superior vena cava (arrowhead in b). These findings suggest that a perforation has occurred. (c) Coronal thin-slab MIP image shows the location of the central venous catheter after correction of the complication.

View larger version (138K): [in a new window]   Figure 8c.  Hemopericardium in a 23-year-old man with non-Hodgkin lymphoma who experienced acute retrosternal pain and dyspnea after central venous cannulation. (a, b) Axial CT images show hemopericardium (arrow in a) and small collections of extraluminal air ventral to the distal superior vena cava (arrowhead in b). These findings suggest that a perforation has occurred. (c) Coronal thin-slab MIP image shows the location of the central venous catheter after correction of the complication.

View larger version (129K): [in a new window]   Figure 9a.  Ventricular perforation by a pacemaker electrode in a 66-year-old woman with acute retrosternal pain, dyspnea, and tachycardia during pacemaker implantation. (a) Axial thin-slab MIP image shows the tip of one pacemaker electrode outside the heart (arrowhead), whereas the other electrode is in a normal position in the left ventricle (arrow). (b) Coronal thin-slab MIP image shows that one electrode is in the correct location, whereas the other electrode has perforated the floor of the right ventricle (arrow). (c) Coronal volume rendered image shows the tip of the perforating electrode. Note the pronounced artifacts due to cardiac motion, which are one of the disadvantages of non-electrocardiographically gated CT.

View larger version (142K): [in a new window]   Figure 9b.  Ventricular perforation by a pacemaker electrode in a 66-year-old woman with acute retrosternal pain, dyspnea, and tachycardia during pacemaker implantation. (a) Axial thin-slab MIP image shows the tip of one pacemaker electrode outside the heart (arrowhead), whereas the other electrode is in a normal position in the left ventricle (arrow). (b) Coronal thin-slab MIP image shows that one electrode is in the correct location, whereas the other electrode has perforated the floor of the right ventricle (arrow). (c) Coronal volume rendered image shows the tip of the perforating electrode. Note the pronounced artifacts due to cardiac motion, which are one of the disadvantages of non-electrocardiographically gated CT.

View larger version (137K): [in a new window]   Figure 9c.  Ventricular perforation by a pacemaker electrode in a 66-year-old woman with acute retrosternal pain, dyspnea, and tachycardia during pacemaker implantation. (a) Axial thin-slab MIP image shows the tip of one pacemaker electrode outside the heart (arrowhead), whereas the other electrode is in a normal position in the left ventricle (arrow). (b) Coronal thin-slab MIP image shows that one electrode is in the correct location, whereas the other electrode has perforated the floor of the right ventricle (arrow). (c) Coronal volume rendered image shows the tip of the perforating electrode. Note the pronounced artifacts due to cardiac motion, which are one of the disadvantages of non-electrocardiographically gated CT.

View larger version (133K): [in a new window]   Figure 10a.  Ventricular perforation in a 35-year-old man after percutaneous pericardial drainage for exudative pericarditis. (a) Axial CT image shows an extensive pericardial effusion with bilateral compression of the cardiac chambers, bilateral pulmonary consolidation, and pleural effusions. Only parts of the percutaneous drainage tube can be seen. (b, c) Coronal (b) and sagittal (c) thin-slab MIP images show the course of the tube, which makes a loop in the pericardial cavity and perforates the right ventricle (arrowhead in c). The end of the tube makes contact with the interventricular septum. (d) Sagittal volume rendered image shows the entire course of the tube (arrowheads). The end of the tube appears to perforate the interventricular septum. This wrong impression is caused by the large slab thickness used to depict the entire course of the tube.

View larger version (130K): [in a new window]   Figure 10b.  Ventricular perforation in a 35-year-old man after percutaneous pericardial drainage for exudative pericarditis. (a) Axial CT image shows an extensive pericardial effusion with bilateral compression of the cardiac chambers, bilateral pulmonary consolidation, and pleural effusions. Only parts of the percutaneous drainage tube can be seen. (b, c) Coronal (b) and sagittal (c) thin-slab MIP images show the course of the tube, which makes a loop in the pericardial cavity and perforates the right ventricle (arrowhead in c). The end of the tube makes contact with the interventricular septum. (d) Sagittal volume rendered image shows the entire course of the tube (arrowheads). The end of the tube appears to perforate the interventricular septum. This wrong impression is caused by the large slab thickness used to depict the entire course of the tube.

View larger version (134K): [in a new window]   Figure 10c.  Ventricular perforation in a 35-year-old man after percutaneous pericardial drainage for exudative pericarditis. (a) Axial CT image shows an extensive pericardial effusion with bilateral compression of the cardiac chambers, bilateral pulmonary consolidation, and pleural effusions. Only parts of the percutaneous drainage tube can be seen. (b, c) Coronal (b) and sagittal (c) thin-slab MIP images show the course of the tube, which makes a loop in the pericardial cavity and perforates the right ventricle (arrowhead in c). The end of the tube makes contact with the interventricular septum. (d) Sagittal volume rendered image shows the entire course of the tube (arrowheads). The end of the tube appears to perforate the interventricular septum. This wrong impression is caused by the large slab thickness used to depict the entire course of the tube.

View larger version (154K): [in a new window]   Figure 10d.  Ventricular perforation in a 35-year-old man after percutaneous pericardial drainage for exudative pericarditis. (a) Axial CT image shows an extensive pericardial effusion with bilateral compression of the cardiac chambers, bilateral pulmonary consolidation, and pleural effusions. Only parts of the percutaneous drainage tube can be seen. (b, c) Coronal (b) and sagittal (c) thin-slab MIP images show the course of the tube, which makes a loop in the pericardial cavity and perforates the right ventricle (arrowhead in c). The end of the tube makes contact with the interventricular septum. (d) Sagittal volume rendered image shows the entire course of the tube (arrowheads). The end of the tube appears to perforate the interventricular septum. This wrong impression is caused by the large slab thickness used to depict the entire course of the tube.

View larger version (101K): [in a new window]   Figure 11a.  Pulmonary embolism due to a lithotriptor fragment in a 31-year-old man after lithotomy for right nephro- and ureterolithiasis. (a) Axial volume rendered image shows a renal calculus (arrow), a percutaneous pigtail catheter, and a fragment of a lithotriptor tip (arrowhead) adjacent to the right renal vein. (b) Axial thin-slab MIP image obtained 2 days later shows that the fragment has migrated along the venous circulation, finally lodging in a branch of the left pulmonary artery (arrowhead). (c) Sagittal thin-slab MIP image shows the fragment in the pulmonary artery branch (arrowhead). (d) Anteroposterior angiogram shows transarterial removal of the fragment with the snare technique.

View larger version (116K): [in a new window]   Figure 11b.  Pulmonary embolism due to a lithotriptor fragment in a 31-year-old man after lithotomy for right nephro- and ureterolithiasis. (a) Axial volume rendered image shows a renal calculus (arrow), a percutaneous pigtail catheter, and a fragment of a lithotriptor tip (arrowhead) adjacent to the right renal vein. (b) Axial thin-slab MIP image obtained 2 days later shows that the fragment has migrated along the venous circulation, finally lodging in a branch of the left pulmonary artery (arrowhead). (c) Sagittal thin-slab MIP image shows the fragment in the pulmonary artery branch (arrowhead). (d) Anteroposterior angiogram shows transarterial removal of the fragment with the snare technique.

View larger version (142K): [in a new window]   Figure 11c.  Pulmonary embolism due to a lithotriptor fragment in a 31-year-old man after lithotomy for right nephro- and ureterolithiasis. (a) Axial volume rendered image shows a renal calculus (arrow), a percutaneous pigtail catheter, and a fragment of a lithotriptor tip (arrowhead) adjacent to the right renal vein. (b) Axial thin-slab MIP image obtained 2 days later shows that the fragment has migrated along the venous circulation, finally lodging in a branch of the left pulmonary artery (arrowhead). (c) Sagittal thin-slab MIP image shows the fragment in the pulmonary artery branch (arrowhead). (d) Anteroposterior angiogram shows transarterial removal of the fragment with the snare technique.

View larger version (128K): [in a new window]   Figure 11d.  Pulmonary embolism due to a lithotriptor fragment in a 31-year-old man after lithotomy for right nephro- and ureterolithiasis. (a) Axial volume rendered image shows a renal calculus (arrow), a percutaneous pigtail catheter, and a fragment of a lithotriptor tip (arrowhead) adjacent to the right renal vein. (b) Axial thin-slab MIP image obtained 2 days later shows that the fragment has migrated along the venous circulation, finally lodging in a branch of the left pulmonary artery (arrowhead). (c) Sagittal thin-slab MIP image shows the fragment in the pulmonary artery branch (arrowhead). (d) Anteroposterior angiogram shows transarterial removal of the fragment with the snare technique.