EDUCATION EXHIBIT 1239 Vascular Emergencies of the Thorax after Blunt and Iatrogenic Trauma: Multi–Detector Row CT and Three- dimensional Imaging 1 ONLINE-ONLY CME See www.rsna .org/education /rg_cme.html. LEARNING OBJECTIVES After reading this article and taking the test, the reader will be able to:  List the imaging appearances of and differential diagnoses for acute vascular injuries of the thorax.  Discuss the values of the different imag- ing modalities for diagnosis of various aortic syndromes.  Describe the clini- cal and CT features of conditions due to iatrogenic vascular trauma of the thorax. Hatem Alkadhi, MD ● Simon Wildermuth, MD ● Lotus Desbiolles, MD Thomas Schertler, MD ● David Crook, MD ● Borut Marincek, MD Thomas Boehm, MD Multi– detector row computed tomographic (CT) angiography is an effective modality for vascular imaging in the thorax. It allows acquisi- tion of high-resolution data sets during a single breath hold, making it the preferred method for evaluation of patients with acute vascular dis- ease. In contrast to conventional angiography, multirow CT angiogra- phy not only depicts the vessels but also allows assessment of adjacent structures. Multirow CT angiography with two- and three-dimensional reformation can be used to diagnose vascular emergencies of the thorax after blunt and iatrogenic trauma. These include incomplete and com- plete aortic rupture; traumatic aortic dissection; arterial dissection and rupture after minor trauma in patients with Ehlers-Danlos syndrome; traumatic intramural hematoma; pseudoaneurysm after endovascular repair; injuries due to Swan-Ganz catheters; complications of central venous cannulation, pacemaker implantation, and percutaneous peri- cardial drainage; and foreign-body embolism. The diagnoses can be es- tablished with multirow CT angiography in the emergency department. Thus, the time to diagnosis can be considerably decreased by obviating conventional angiography. Knowledge of the CT findings in various vas- cular conditions is essential to make use of multirow CT angiography in combination with two- and three-dimensional reformation as an effi- cient and accurate diagnostic tool in emergency radiology. © RSNA, 2004 Abbreviation: MIP = maximum intensity projection Index terms: Arteries, injuries, 56.126, 94.126, 56.40, 94.40 ● Computed tomography (CT), multi– detector row, 50.12116, 94.12916 ● Heart, inter- ventional procedures, 51.126, 51.40 ● Interventional procedures, complications, 50.126, 94.126, 50.40, 94.40 ● Thorax, injuries, 50.40, 94.40 ● Tho- rax, interventional procedures, 50.126, 94.126, 50.40, 94.40 RadioGraphics 2004; 24:1239 –1255 ● Published online 10.1148/rg.245035728 ● Content Codes: 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 re- ceived February 23; accepted March 8. Supported by the NCCR CO-ME of the Swiss National Science Foundation. All authors have no financial re- lationships to disclose. Address correspondence to T.B. (e-mail: thomas_boehm@gmx.net). © RSNA, 2004 RadioGraphics