Đánh giá hình ảnh: Tính năng chụp cắt lớp vi tính trong các trường hợp khẩn cấp về tim mạch và suy giảm sắp xảy ra

Emergency Radiology - Tập 18 - Trang 127-138 - 2010
Tow Non Yeow1, Vikram Muppalla Raju1, Nanda Venkatanarasimha1, Bruce M. Fox1, Carl A. Roobottom2
1Peninsula Radiology Academy, Plymouth, UK
2Professor of Radiology, Peninsula Medical School, Peninsula Radiology Academy, Plymouth, UK

Tóm tắt

Máy chụp cắt lớp vi tính nhiều đầu detector (MDCT) hiện có tại hầu hết các bệnh viện và ngày càng được sử dụng như là phương pháp hình ảnh hàng đầu trong các trường hợp chấn thương và các tình huống khẩn cấp về tim mạch nghi ngờ, chẳng hạn như hội chứng vành cấp, thuyên tắc động mạch phổi, phình động mạch chủ bụng và xuất huyết cấp tính (Ryan et al. Clin Radiol 60:599–607, 2005). Một số lượng đáng kể các bệnh nhân này không ổn định về hemodynamics và có thể nhanh chóng tiến triển thành sốc và tử vong. Việc nhận diện các dấu hiệu chụp cắt lớp vi tính (CT) của sự suy giảm tim mạch sắp xảy ra sẽ cảnh báo bác sĩ chẩn đoán hình ảnh lâm sàng về sự hiện diện của sốc. Trong bài đánh giá này, các phát hiện hình ảnh liên quan đến các tình huống khẩn cấp về tim mạch trong cả tình huống chấn thương cấp tính và không chấn thương sẽ được mô tả và minh họa.

Từ khóa

#chụp cắt lớp vi tính #khẩn cấp về tim mạch #suy giảm #hemodynamics #hội chứng vành cấp #thuyên tắc động mạch phổi #phình động mạch chủ bụng

Tài liệu tham khảo

Ryan MF, Hamilton PA, Sarrazin J, Chu J et al (2005) The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol 60:599–607. doi:10.1016/j.crad.2004.02.012 Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L (1997) Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 43(3):405–411. doi:10.1097/00005373-199709000-00003 Omert L, Yeaney WW, Protetch J (2001) Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg 67(7):660–664 Petre R, Chilcott M (1997) Blunt trauma to the heart and great vessels. N Engl J Med 336:626–632. doi:10.1056/NEJM199702273360906 Wong H, Gotway MB, Sasson AD, Jeffrey RB (2004) Periaortic hematoma at diaphragmatic crura at helical CT: sign of blunt aortic injury in patients with mediastinal hematoma. Radiology 231(1):185–189. doi:10.1148/radiol.2311021776 Rob M, Arlene A, Franchetto (1996) The CT appearance of aoartic transaction. AJR 166:647–651 Maenza RL, Seaberg D, D’Amico F (1996) A meta-analysis of blunt cardiac trauma; ending myocardial confusion. Am J Emerg Med 14:237–241. doi:10.1016/S0735-6757(96)90165-5 Banning AP, Durrani A, Pillai R (1997) Rupture of the atrial septum and tricuspid valve after blunt chest trauma. Ann Thorac Surg 64:240–242. doi:10.1016/S0003-4975(97)00275-0 Perlroth MG, Hazan E, Lecompte Y, Gougne G (1986) Chronic tricuspid regurgitation and bifascicular block due to blunt chest trauma. Am J Med Sci 291:119–125. doi:10.1097/00000441-198602000-00008 Restrepo CS, Lemos DF, Lemos JA, Velasquez E et al (2007) Imaging findings in cardiac tamponade with emphasis on CT. Radiographics 27(6):1595–1610. doi:10.1148/rg.276065002 Spodick DH (1998) Pathophysiology of cardiac tamponade. Chest 113:1372–1378. doi:10.1378/chest.113.5.1372 Hernandez-Luyando L, Calvo J, Gonzalez de las Heras E, dela Puente H, Lopez C (1996) Tension pericardial collections: sign of “flattened heart” in CT. Eur J Radiol 23:250–252. doi:10.1016/S0720-048X(96)00781-4 Harries SR, Fox BM, Roobottom CA (1998) Azygos reflux: a CT sign of cardiac tamponade. Clin Radiol 53(9):702–704. doi:10.1016/S0009-9260(98)80299-7 Hoffmann U, Bamberg F, Chae CU, Nichols JH et al (2009) Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol 5;53(18):1651–1652. doi:10.1016/j.jacc.2009.01.052 Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA et al (2007) A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 27;49(8):863–871. doi:10.1016/j.jacc.2006.08.064 Hoffmann U, Nagurney JT, Moselewski F, Pena A et al (2006) Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 21;114(21):2251–2260. doi:10.1161/CIRCULATIONAHA.106.634808 Ghaye B, Remy J, Remy-Jardin M (2002) Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years. Eur Radiol 12:1886–1905 Anderson DR, Kovacs MJ, Dennie C et al (2005) Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department. J Emerg Med 29:399–404. doi:10.1016/j.jemermed.2005.05.010 Schoepf UJ, Kucher N, Kipfmueller F et al (2004) Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 110:3276–3280. doi:10.1161/01.CIR.0000147612.59751.4C Stavros V, Konstantinides MD (2008) Massive pulmonary embolism: what level of aggression? Semin Respir Crit Care Med 29(1):47–55. doi:10.1055/s-2008-1047562 Prêtre R, Von Segesser LK (1997) Aortic dissection. Lancet 17;349(9063):1461–1464. doi:10.1016/S0140-6736(96)09372-5 Roberts CS, Roberts WC (1991) Aortic dissection with the entrance tear in abdominal aorta. Am Heart J 121(6 Pt 1):1834–1835. doi:10.1016/0002-8703(91)90044-I Erbel R, Alfonso F, Boileau C et al (2001) Diagnosis and management of aortic dissection. Eur Heart J 22:1642–1681. doi:10.1053/euhj.2001.2782 Sarasin FP, Louis-Simonet M, Gaspoz JM, Junod AF (1996) Detecting acute thoracic aortic dissection in the emergency department: time constraints and choice of the optimal diagnostic test. Ann Emerg Med 28:278–288. doi:10.1016/S0196-0644(96)70026-4 Hayter RG, Rhea JT, Small A, Tafazoli FS, Novelline RA (2006) Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology 238(3):841–852. doi:10.1148/radiol.2383041528 Batra P, Bigoni B, Manning J, Aberle DR, Brown K et al (2000) Pitfall in diagnosis of thoracic aortic dissection at CT angiography. Radiographics 20(2):309–320 Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y (2006) Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med 10;166(13):1350–1356. doi:10.1001/archinte.166.13.1350 Maraj R, Rerkpattanapipat P, Jacobs LE, Makornwattana P, Kotler MN (2000) Meta-analysis of 143 reported cases of aortic intramural hematoma. Am J Cardiol 86:664–668. doi:10.1016/S0002-9149(00)01049-3 Fisher ER, Stern EJ, Godwin JD II, Otto CM, Johnson JA (1994) Acute aortic dissection: typical and atypical imaging features. RadioGraphics 14:1263–1271 Yamada T, Tada S, Harada J (1998) Aortic dissection without intimal rupture: diagnosis with MR imaging and CT. Radiology 168:347–352 Murray JG, Manisali M, Flamm SD et al (1997) Intramural hematoma of the thoracic aorta: MR image findings and their prognostic implications. Radiology 204:349–355 Nienaber CA, von Kodolitsch Y, Petersen B et al (1995) Intramural hemorrhage of the thoracic aorta: diagnostic and therapeutic implications. Circulation 92:1465–1472. doi:10.1016/0736-4679(96)84809-8 Ledbetter S, Stuk JL, Kaufman JA (1999) Helical (spiral) CT in the evaluation of emergent thoracic aortic syndromes: traumatic aortic rupture, aortic aneurysm, aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Radiol Clin North Am 37:575–589 Sebastià C, Pallisa E, Quiroga S, Alvarez-Castells A et al (1999) Aortic dissection: diagnosis and follow-up with helical CT. Radiographics 19(1):45–60 Chest pain of recent onset. Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin: NICE clinical guideline, 2010. Available at http://www.nice.org.uk/guidance/CG95 Becker RC, Charlesworch A, Wilcox RG et al (1995) Cardiac rupture associated with thrombolytic therapy: impact of time to treatment in the late assessment of thrombolytic efficacy (LATE) study. J Am Coll Cardiol 25:1063–1068. doi:10.1016/0735-1097(94)00524-T Nishimura RA, Schaff HV, Shub C, Gersh BJ, Edwards WD, Tajik AJ (1983) Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients. Am J Cardiol 51:373–377. doi:10.1016/S0002-9149(83)80067-8 Voci P, Bilotta F, Caretta Q, Mercanti C, Marino B (1995) Papillary muscle perfusion pattern. A hypothesis for ischemic papillary muscle dysfunction. Circulation 91:1714–1718 Kim TH, Seung KB, Kim PJ, Baek SH, Chang KY, Shin WS, Choi KB, Moon SW (2005) Images in cardiovascular medicine. Anterolateral papillary muscle rupture complicated by the obstruction of a single diagonal branch. Circulation 112:269–270. doi:10.1161/CIRCULATIONAHA.104.505016 Moreno R, Lopez de Sa E, Lopez-Sendon JL, Garcia E, Soriano J, Abeytua M et al (2000) Frequency of left ventricular free-wall rupture in patients with acute myocardial infarction treated with primary angioplasty. Am J Cardiol 85:757–760. doi:10.1016/S0002-9149(99)00855-3 Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC (2003) Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era. Chest 124:565–571. doi:10.1378/chest.124.2.565 Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tomlinson G (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology 249(2):524–533. doi:10.1148/radiol.2492072055 Anderson PA, Henley MB, Rivara FP, Maier RV (1991) Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma 5(2):153–160. doi:10.1097/00005131-199105020-00006 Glazer GM, Buy JN, Moss AA, Goldberg HI, Federle MP (1981) CT detection of duodenal perforation. AJR 137(2):333–336 Orwig D, Federle MP (1989) Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR 153(4):747–749 Brody JM, Leighton DB, Murphy BL et al (2000) CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. RadioGraphics 20:1525–1537 Shamji FM, Todd TRJ (1985) Hypovolemic shock. Symposium on cardiovascular crises in the critically ill. Crit Care Clin 1985:1 Sivit CJ, Taylor GA, Bulas DI, Kushner DC et al (1992) Posttraumatic shock in children: CT findings associated with haemodynamic instability. Radiology 182:723–726. doi:10.1016/0736-4679(92)90175-S Hara H, Babyn PS (1992) Significance of bowel wall enhancement on CT following blunt abdominal trauma in children. J Comput Assist Tomogr 16:94–98. doi:10.1097/00004728-199201000-00017 RothC SM, Bogot N, Todd M, Cronin P (2006) Dependent venous contrast pooling and layering: a sign of imminent cardiogenic shock. AJR 186:1116–1119. doi:10.2214/AJR.04.1850 Jeffrey RB Jr, Federle MP (1988) The collapsed inferior vena cava: CT evidence of hypovolemia. AJR 150:431–432 Shin MS, Berland LL, Ho KJ (1990) Small aorta: CT detection and clinical significance. J Comput Assist Tomogr 14:102–103. doi:10.1097/00004728-199001000-00018 Taylor GA, Fallat ME, Eichelberger MR (1987) Hypovolemic shock in children: abdominal CT manisfestations. Radiology 164:479–481 O’Hara SM, Donnelly LF (1999) Intense contrast enhancement of the adrenal glands: another abdominal CT finding associated with hypoperfusion complex in children. AJR Am J Roentgenol 173(4):995–997 Goodman LR, Aprahamian C (1990) Changes in splenic size after abdominal trauma. Radiology 176:629–632 Siegel CL, Cohan RH, Korobkin M, Alpern MB, Courneya DL, Leder RA (1994) Abdominal aortic aneurysm morphology: CT features in patients with ruptured and non-ruptured aneurysms. AJR 163:1123–1129 Rakita D, Newatia A, Hines JJ, Siegel DN, Friedman B (2007) Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. Radiographics 27(2):497–507. doi:10.1148/rg.272065026