Sudden cardiac arrest during computed tomography examination: clinical findings and "dense abdominal veins" on...

We report imaging findings in five patients who had sudden cardiac arrest during contrast-enhanced computed tomography (CT). We observed strikingly dense abdominal veins, variable degrees of arterial enhancement, and poor abdominal visceral enhancement. Comparison with a control group of 30 patients revealed a statistically significant increase in mean enhancement of the abdominal veins (including the inferior vena cava, bilateral renal veins, and major tributaries of the hepatic vein) (Kruskal-Wallis test, P< 0.05). These patients lacked any clear cause of cardiac arrest, and the arrest may have been related to an adverse reaction to contrast medium. Despite resuscitation, two patients died and three convalesced. In summary, sudden cardiac arrest is characterized by "dense abdominal veins" on CT in the absence of the cardiac pump function. This effect was presumably the result of forced reflux and stagnation of contrast medium in the abdominal veins without any dilution with the circulating blood, leading to a markedly dense appearance of these venous structures.