CT features of hypoperfusion complex and pre-cardiac arrest: a pictorial review

Abstract

KEY LEARNING OBJECTIVES: To review and illustrate the varied enhancement patterns on CT of solid visceral organs, bowel and vessels in the context of global hypoperfusion and discuss the pathophysiology and prognostic significance of these appearances. DESCRIPTION: Understanding and recognition of the enhancement patterns of different organs on CT in the context of hypoperfusion can aid in differentiation from solid organ injury, thereby facilitating prompt and timely diagnosis. Several signs of hypoperfusion complex on CT are also of prognostic significance and their recognition may be useful in directing patient management. In this review we aim to demonstrate the main features on CT of hypoperfusion of each major organ, including pre-arrest appearances on CT, the bowel with ‘shock bowel’, plus vascular structures such as the IVC and aorta with ‘shock vessel’ and ‘the halo sign’. CONCLUSION: Armed with the knowledge from this review, radiologists should be well-equipped to recognise the CT features of hypoperfusion complex and pre-arrest, as well as being able to use these features to differentiate from solid organ injury. As several of these CT features are prognostic indicators, radiologists may also be able to use them to advise on patient triaging and any potential need for early critical care referral.