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Imaging findings of acute intravascular thrombus on non-enhanced computed tomography

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Abstract

Intravascular thrombosis and thromboembolism are critical diagnoses which are frequently made on contrast-enhanced computed tomography (CECT) or Doppler ultrasound. For a variety of reasons, some patients with acute intravascular pathology are imaged using CT without intravenous contrast. In the acute setting, the increased Hounsfield unit (HU) density of the thrombus compared to the blood pool allows the diagnosis to be made, or at least suggested, on non-enhanced computed tomography (NECT). The increased density of the clot is commonly referred to as the “hyperdense vessel sign.” This is a well-known finding in the setting of stroke, but hyperdense vessels can also signal arterial or venous thrombosis in the chest, abdomen, pelvis, and extremities. Once a hyperdense vessel sign is noted on NECT, further exploration with CECT, angiography, or ultrasound may then be performed. Here, we present a pictorial review of the appearance of acute intravascular thrombosis as seen on non-enhanced computed tomography.

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Acknowledgments

The authors would like to thank Dr. Jeffrey A. Breall, Professor of Clinical Medicine and director of Interventional Cardiology at the Krannert Institute of Cardiology, Indiana University School of Medicine, for providing the cardiac catheter images seen in Fig. 4c, d.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Room AG-176, Indianapolis, IN, 46202, USA

    Ryan T. Whitesell & Scott D. Steenburg

  2. Department of Radiology and Imaging Sciences, Division of Emergency Radiology, Indiana University School of Medicine, Indianapolis, IN, USA

    Scott D. Steenburg

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  1. Ryan T. Whitesell
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  2. Scott D. Steenburg
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Correspondence to Scott D. Steenburg.

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Whitesell, R.T., Steenburg, S.D. Imaging findings of acute intravascular thrombus on non-enhanced computed tomography. Emerg Radiol 21, 271–277 (2014). https://doi.org/10.1007/s10140-014-1210-8

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  • DOI: https://doi.org/10.1007/s10140-014-1210-8

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