Upper limb computed tomography (CT) angiography in the emergency department

Area of Science:

• Radiology
• Vascular Imaging
• Emergency Medicine

Background:

• Acute upper limb (UL) vascular abnormalities stem from trauma, peripheral vascular disease, and inflammatory conditions.
• Computed tomography angiography (CTA) is increasingly used for rapid, noninvasive evaluation of UL arterial pathology.
• CTA allows simultaneous assessment of osseous and soft tissue injuries, unlike traditional digital subtraction angiography (DSA).

Purpose of the Study:

• To describe the spectrum of imaging findings on upper limb CTA for acute presentations.
• To highlight the utility of CTA in diagnosing traumatic, atherosclerotic, and inflammatory vascular conditions of the UL.
• To emphasize the importance of a robust CTA protocol and knowledge of normal anatomy for accurate diagnosis.

Main Methods:

• Review of upper limb CTA studies in patients with acute vascular presentations.
• Correlation of imaging findings with clinical diagnoses including trauma, peripheral vascular disease, and vasculitis.
• Description of characteristic CTA findings such as contrast extravasation, pseudoaneurysm, occlusion, arteriovenous fistula, atherosclerotic plaques, and arterial mural thickening.

Main Results:

• CTA effectively identifies traumatic vascular injuries (e.g., extravasation, pseudoaneurysm, fistula) from blunt or penetrating aetiologies.
• Peripheral vascular disease is visualized as atherosclerotic plaques leading to reduced downstream opacification and potential thromboembolic events.
• Inflammatory conditions like vasculitis show characteristic arterial wall thickening on CTA.

Conclusions:

• CTA is a valuable tool for the rapid, noninvasive diagnosis of diverse acute upper limb vascular pathologies.
• Accurate interpretation relies on understanding normal UL arterial anatomy and employing optimized CTA protocols.
• Adjunctive modalities like ultrasound and magnetic resonance angiography (MRA) may be considered for further characterization when necessary.