INDICATIONS

The progress made by transitioning from axial imaging of soft tissue (with single-detector CT scanners) to volumetric imaging (by multidetector CTs [MDCTs]) has revolutionized vascular studies. Arteries and veins throughout the body can now be visualized in 3D reconstructions and rotated to see an aneurysm's full contour, for example, or visualized in planes to determine the extent of the tear of an arterial dissection. Physicians in multiple specialties are learning to incorporate MDCT-generated vascular studies to see critical lesions — for the oncologist, the technology can clarify the extent of involvement of a cancerous lesion around a vein; the cardiologist obtains, with a brief period of noninvasive imaging, intensely detailed 3D information on coronary vessel plaques and patencies. The emergent use of MDCT angiography (MDCTA) of the abdomen in the ED is in its nascent stages, but promises to be a powerful tool for evaluation of a patient in whom the ED physician suspects a vascular catastrophe. Clots, bleeds, tears, and aneurysms can each represent limb- or life-threatening pathological processes. CT angiography (CTA) of the abdomen can truly alter management and dispositions.

DIAGNOSTIC CAPABILITIES

Aortoiliac System

Leaking or dissecting abdominal aortas, along with similar lesions in the iliac vessels, are among the most anxiety-provoking diagnoses for the emergency medicine physician.