Computed tomography venography of the upper extremities — Using low dose bilateral contrast media injection in a patient with suspected venous thoracic outlet syndrome
“…5 a–d) Magnetic Resonance Imaging (MRI) can highlight the main signs of TOS, but is mainly used in children to avoid the radiological risk related to the ionizing radiation [ 14 ]. Multidetector Computed Tomography (MDCT) is used in the diagnosis of TOS for its overview and high accuracy for vascular structures [ 15 ]; moreover, even if burdened by radiological risk, recent technological developments have made it possible to lower radiation doses, without compromising image quality [ 16 ]. Fig.…”
Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
“…5 a–d) Magnetic Resonance Imaging (MRI) can highlight the main signs of TOS, but is mainly used in children to avoid the radiological risk related to the ionizing radiation [ 14 ]. Multidetector Computed Tomography (MDCT) is used in the diagnosis of TOS for its overview and high accuracy for vascular structures [ 15 ]; moreover, even if burdened by radiological risk, recent technological developments have made it possible to lower radiation doses, without compromising image quality [ 16 ]. Fig.…”
Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
“…Svensson and colleagues used 45 mL of 1:10 diluted IC, and scanning at 12 seconds; thus, less than 5 mL of IC was used in their study. 11 We used 1:4 diluted IC, which is similar to that used by Kuo et al who injected IC into both femoral veins. 12 Total volume of of IC used in our patients was 38 mL, and we simultaneously injected IC into both arms to avoid inflow phenomenon at the superior vena cava (SVC), which is a common problem with single arm injection.…”
Section: Discussionmentioning
confidence: 99%
“…However, there were only 19 patients in that study. 2 Multiple contrast agents can be used for venography other than IC such as carbon monoxide 11,13 or gadoterate meglumine 12,14 which provide high quality images but are not feasible for use because of their availability. Non-contrast enhanced MRV has been proposed in patients who want cannot endure risk from either the contrast agent or radiation 13,15 , even though contrastenhanced MRV has a higher diagnostic odds ratio than non-contrast techniques.…”
Objective: The aims of this study were to describe direct computed tomography venography (CTV) for upper limb venous system evaluation and to report on findings in end-stage renal disease (ESRD) patients.Materials and Methods: Direct CTV was performed using a 64-multidetector computed tomography (MDCT) scanner with simultaneous injection of diluted iodinated contrast (IC); 1:4 at both elbows and 2-phase scanning namely, the direct venous, and the arterial phases. The findings in ESRD patients evaluated between November 2013 and March 2019 were retrospectively reviewed.Results: Forty CTV examinations (600 venous segments) were performed and the volume of IC used per patient was 38 mL. Number of lesions found in a patient ranged from 1 to 6 and the majority had 1 to 3 lesions (30/38 patients). Stenosis and thrombosis were the two most common findings (112/600) and were equally prevalent. The three most common sites of steno-occlusive complications were the brachiocephalic vein (29 lesions), the internal jugular vein (25 lesions), and the subclavian vein (16 lesions). The most common site of stenosis was the brachiocephalic vein (18 lesions), whereas the most common site of thrombosis was the internal jugular vein (20 lesions). No venous aneurysms or ruptures were found. IC extravasation at the site of injection occurred in one arm in one patient.Conclusion: Direct CTV has the advantage of requiring lower IC volume while maintaining direct visualization of the venous system similar to conventional venography.
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