Valente Tullio, Bocchini Giorgio, Massimo Candida, Rea Gaetano, Lieto Roberta, Guarino Salvatore, Muto Emanuele, Abu-Omar Ahmad, Scaglione Mariano, Sica Giacomo
Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy.
Department of Radiology, Vancouver General Hospital, 899 W 12th Avenue, Vancouver, BC V5Z 1M9, Canada.
Diagnostics (Basel). 2023 Jul 7;13(13):2304. doi: 10.3390/diagnostics13132304.
A severe mismatch between the supply and demand of oxygen is the common sequela of all types of shock, which present a mortality of up to 80%. Various organs play a protective role in shock and contribute to whole-body homeostasis. The ever-increasing number of multidetector CT examinations in severely ill and sometimes unstable patients leads to more frequently encountered findings leading to imminent death, together called "hypovolemic shock complex". Features on CT include dense opacification of the right heart and major systemic veins, venous layering of contrast material and blood, densely opacified parenchyma in the right hepatic lobe, decreased enhancement of the abdominal organ, a dense pulmonary artery, contrast pooling in dependent lungs, and contrast stasis in pulmonary veins. These findings are biomarkers and prognostic indicators of paramount importance which stratify risk and improve patient outcomes. In this review, we illustrate the various CT patterns in shock and review the spectrum and prognostic significance of thoraco-abdominal vascular and visceral alarming signs of impending death with the intention of increasing awareness among radiologists and radiographers to prepare for immediate resuscitation when required.
氧供需严重不匹配是各类休克的常见后遗症，其死亡率高达80%。各种器官在休克中发挥保护作用并有助于维持全身内环境稳定。在重症且有时不稳定的患者中，多排CT检查数量不断增加，导致更多常出现的即将死亡的影像学表现，统称为“低血容量性休克综合征”。CT表现包括右心和主要体静脉致密强化、对比剂与血液的静脉分层、右肝叶实质致密强化、腹部器官强化减弱、肺动脉致密、下垂肺野对比剂积聚以及肺静脉对比剂滞留。这些表现是极其重要的生物标志物和预后指标，可对风险进行分层并改善患者预后。在本综述中，我们阐述了休克中的各种CT表现模式，并回顾了胸腹部血管及内脏即将死亡的警示征象的范围和预后意义，旨在提高放射科医生和放射技师的认识，以便在需要时为立即复苏做好准备。
