<Home // About Us // Privacy Statement // Advertising Policy // Contact Us

Case 64: CT angiogram

A 72 year old man is being worked up for management of an asymptomatic AAA. He has a CT angiogram with 3D reconstruction shown below.

1. What is the main limitation of traditional angiography for assessment of anurysmal disease?

Angiography involves rapid injection of intra-arterial contrast with fluoroscopic screening. In digital subtraction angiography a preliminary film is taken and then subtracted from the angiogram film of the same body region. This provides clear definition of the arteries involved without background bone and soft tissue images. The major limitation is that the contrast demonstrates the lumen of the vessel only. As such in aneurysmal disease it may dramatically underestimate the true diameter of an aneurysm lined by extensive mural thrombus.

2. Identify the arteries A to E

A - splenic artery
B - superior mesenteric artery
C - common hepatic artery
D - right renal artery
E - left common femoral artery

3. Which midline visceral artery appears absent and why?

The inferior mesenteric artery is not seen. This is because it is often occluded or small in the setting of a large AAA with atherosclerosis and mural thrombus involving the origin of the IMA. If no contrast is in the artery then it will not be seen using this imaging technique.