Download CT Clinical Case Study Trauma CT Occlusion Superficial Femoral

GE Healthcare
CT Clinical Case Study
Trauma CT
Occlusion Superficial
Femoral Artery (SFA)
Jorge Soto, M.D.
Stephan Anderson, M.D.
Boston University Medical Center
Boston, MA
imagination at work
CT Clinical Case Study
Trauma CT
Occlusion Superficial Femoral Artery (SFA)
Jorge Soto, M.D.
Stephan Anderson, M.D.
Boston University Medical Center
Boston, MA
Figure 1
Oblique Angio View demonstrating
thrombosis within the Left Femoral Artery.
Patient History
A 14-year-old male presented to the emergency department with injuries sustained
to the left lower extremity and pulsatile bleeding that he obtained from a rollover
All-Terrain Vehicle (ATV) collision. A Computed Tomography Angiography (CTA) of the
left lower extremity was requested by the referring emergency physcian for further
evalution of the patient’s injuries.
Acquisition Protocol
Scanner:
Scan Type:
Rotation Speed:
Detector Configuration:
Slice Thickness:
Pitch:
SFOV:
DFOV:
kVp:
mA:
Total Scan Time:
Figure 2
Lateral Angio View demonstrating
thrombosis within the Left Femoral Artery.
LightSpeed® VCT
Helical
0.5 seconds
64 x 0.625
0.0625mm
0.516:1
50.0cm
36.0cm
120
200mA
15.8 seconds
Contrast Injection Parameters
Using a Double-Barrel Injector:
• Prep Delay = 25 seconds
• 100ml of contrast at 5cc/sec.
+30 ml of saline at 5cc/sec.
Contrast Type: Non-Ionic 320mg I/ml
Clinical Findings
The CTA exam assisted the radiologist in determining the following clinical diagnostic
imaging findings:
1. There is a traumatic thrombosis within the left Superficial Femoral Artery (SFA) in
the region of the soft tissue abnormality secondary to the patient’s injury. The
lumen of the vessel is totally absent distally from this level until reconstitution is
seen from the superior geniculate arteries in the region of the popliteal fossa.
2. The popliteal artery reconstitutes and then demonstrates a normal trifurcation.
3. The distal anterior tibial artery is not clearly seen.
Figure 3
Oblique Angio View demonstrating popliteal
artery with normal trifurcation.
Figure 4
Lateral Angio View demonstrating popliteal
artery with normal trifurcation.
Figure 6
Oblique Bone/Vessel Transparency View
demonstrating popliteal artery with normal
trifurcation.
Figure 7
Axial MIP View demonstrating subcutaneous
emphysema throughout the fascial planes.
4. There is subcutaeous emphysema seen throughout the
fascial planes in the region of the patient’s injury.
5. There are no fractures.
Discussion
Based on the CTA findings the patient went directly to surgery
for surgical intervention to restore blood flow to the left lower
extremity. Because there was extensive damage to the
Superfiical Femoral Vein (SFV) and SFA, the SFV was ligated to
ensure no future bleeding and a portion of the SFA was
resected, leaving a substantial gap. Therefore, a segment of
the Saphenous Vein was used to graph the dissected SFA both
Figure 5
Oblique Bone/Vessel Transparency View
demonstrating thrombosis within the left
femoral artery.
proximally and distally to restore blood flow. In addition, due
to the prolonged ischemic time to the patient’s left lower
extremity, four compartment fasciotomys were also done at
the time of surgery to help control swelling of the leg to avoid
compromising blood flow in the graft.
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CT-0253-02.06-EN-US