Vascular injuries of the neck and thoracic inlet: helical CT-angiographic correlation

Imaging evaluation of patients suspected to have arterial injuries of the neck has traditionally been performed by using conventional angiography as an alternative to surgical exploration. However, there has been recent interest in and growing experience with use of noninvasive imaging techniques for the assessment of vascular injuries. Contrast material-enhanced helical computed tomographic (CT) angiography is increasingly being used to evaluate trauma patients in stable condition who are at risk for vascular injuries. It allows characterization of traumatic vascular lesions in the neck such as partial or complete occlusion, pseudoaneurysm, intimal flap, dissection, and arteriovenous fistula. In the same setting, CT angiography provides valuable additional information about the cervical soft tissues, aerodigestive tract, spinal canal, and spinal cord. In cases of penetrating gunshot injuries, the trajectory of the bullet and the locations of fragments can be assessed. CT angiography may be limited by artifacts from metallic fragments and occasionally by abundant soft-tissue air or streak artifacts in the shoulders. In such cases, conventional angiography is necessary for optimal assessment of vascular injuries. CT angiography can be used as a noninvasive alternative to conventional angiography in patients suspected to have vascular injuries but without initial indications for surgical treatment.