대한흉부영상의학회 Korean Society of Thoracic Radiology GuerBet

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 955 Date 2016-02-15

  • Courtesy of Eun Sil Kim, Ki Yeol Lee / Korea University Medical Center Ansan Hospital
  • Age/Sex 18 / M
  • Chief ComplaintMotorcycle traffic accident
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8

Diagnosis With Brief Discussion

Diagnosis
Cardiac arrest
Radiologic Findings
The chest AP radiograph demonstrates diffuse ground glass opacity in the right lung and left upper lobe, suggestive lung contusion or pulmonary hemorrhage. Widening of upper mediastinum is also suspected.
On mediastinal settings of contrast enhanced chest CT, high density fluid collection is noted in the anterior mediastinum. The distal trachea and both main bronchi are not visualized. Therefore the possibility of mediastinal hematoma is suggested. In addition, dependent pooling of contrast and layering is seen in the azygos vein, hepatic/renal veins, within the dependent part of the IVC, the right heart chambers, and the hepatic/renal parenchyma,. There is no significant opacification of the left cardiac chambers and the aorta. These findings conclude cardiac arrest at the time of CT scan.
On the bone windows, fractures at both 1st ribs and manubrium are also seen.
Brief Review
Imaging a patient during a cardiac arrest is not a common occurrence. The imaging findings of sudden cardiac arrest during CT examination have been described in a few case reports only.
CT findings of cardiac arrest include dependent pooling and layering of contrast in the venous system, with faint or no opacification of the left sided cardiac chambers, aorta, and the abdominal organs. Injected contrast is seen layering in lumbar veins, hepatic and renal veins and parenchyma, and within the dependent part of the IVC and the right sided cardiac chambers. These findings can be explained by poor cardiac function, with failure to propel blood against gravity. If the heart stops pumping, the systemic arterial and venous pressures drop significantly, with loss of the arteriovenous pressure gradient. So the distribution of injected contrast material depends on the pressure with which the contrast is injected and the density of the contrast agent. Also the left sided cardiac chambers, aorta, and the abdominal organs are not well opacified by the contrast media.
The radiologist should be aware of the imaging findings so that any further imaging is discontinued and proper resuscitative measures can be taken immediately..
References
Roth C, Sneider M, Bogot N, Todd M, Cronin P. Dependent venous contrast pooling and layering: A sign of imminent cardiogenic shock. AJR 2006;186:1116–9.
Singh AK, Gervais D, Mueller P, Shirkhoda A, Sagar P, Mccarroll K. Cardiac arrest: Abdominal CT imaging features. Abdom Imaging. 2004;29:177–9.
Manisha Jana, Shivanand Ramachandra Gamanagatti, Atin Kumar. Case series: CT scan in cardiac arrest and imminent cardiogenic shock. Indian J Radiol Imaging. 2010;20(2):150–153.
Keywords
Lung, Vascular, Vascular,

No. of Applicants : 79

▶ Correct Answer : 29/79,  36.7%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - SNUBH , Korea (South) Chee Guen
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - Neurociti Diagnostics , India Justin Moses
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Chosun university hospital , Korea (South) Hyungwoo Oh
  • - UWO , Canada S Lee
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Medicheck health care , Korea (South) Chae Lim
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - Goa Medical College , India Paresh Desai
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - University of Tsukuba, Dept of Radiologt , Japan Manabu Minami
  • - CHU Poitiers , France CHAN paul
  • - GHICL , France manuel toledano
  • - Shinmatsudo Central General Hospital , Japan Taku Tajima
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Asan , Korea (South) Sania ALBlushi
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Kyoto University , Japan Akihiko Sakata
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
▶ Correct Answer as Differential Diagnosis : 1/79,  1.3%
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

This website is optimized for IE 10 and above.