Multidetector CT and three-dimensional CT angiography of upper extremity arterial injury

Successful management of upper extremity arterial injury requires fast and accurate diagnosis. The rate of limb preservation depends on the location, severity, and time of ischemia. Indications for diagnostic imaging depend on the mechanism and type of injury, clinical signs, cardiovascular stability, and clinical suspicion. Because of ease of access, speed, and high accuracy for this diagnosis, multidetector computed tomographic (MDCT) angiography is often used as the first line imaging modality. MDCT systems with 64 slice configuration and more afford high temporal and spatial high-resolution, isotropic data acquisition and integration with whole-body trauma MDCT protocols. The use of individual injection timing protocols ensures high diagnostic image quality. Several strategies are available to reduce radiation exposure. Direct MDCT angiography findings of arterial injuries include active extravasation, luminal narrowing, lack of luminal contrast opacification, filling defect, arteriovenous fistula, and pseudoaneurysm. Important descriptors are location and length of defect, degree of luminal narrowing, and presence of distal arterial supply reconstitution. Proximal arterial injuries include the subclavian, axillary, and brachial arteries. Distal arterial injuries include the ulnar and radial arteries, as well as the palmar arterial arches. Concomitant venous injury, musculoskeletal injury, and nerve damage are common. In this exhibit, we outline the role of MDCT angiography in the diagnosis and management of upper extremity arterial injury, discuss strategies for MDCT angiography acquisition and concepts of data visualization, and illustrate various types of injuries.