CT angiography findings in sudden cardiac arrest.

In critically-ill and unstable patient, computed tomography (CT) performed with intravenous administration of contrast material conveys a high risk of sudden cardiac arrest during the examination due to volume overload in association with limited cardiac output. We report herein sudden cardiac arrest that occurred during CT angiography in a 60-year-old man with respiratory distress due to COVID-19 pneumonia and metabolic acidosis. CT angiography was performed to exclude mesenteric ischemia. CT angiography revealed diffuse pooling of contrast with typical “level-sign” in the right auricle, vena cava and multiple dependent veins and a white lung appearance consistent with COVID-19 pneumonia [1]. Preliminary signs of imminent cardiac arrest were visible, including poor content of contrast material in the aorta and left heart, interrupted enhancement of the pulmonary artery and major spasm of the visceral arteries (Fig. 1 ) [2]. Despite immediate resuscitation maneuvers, the patient did not revive. Radiologists must know these critical signs that require prompt and appropriate management.

Fig. 1

A 60-year-old man with respiratory distress due to COVID-19 pneumonia and metabolic acidosis who experienced sudden cardiac arrest during CT angiography (CTA). a: volume rendered CTA image of the thorax, abdomen and pelvis in the coronal plane shows marked pooling of contrast material in the entire vena cava (black arrow) and retrograde opacification of hepatic and lower right hepatic veins (white arrows) and renal veins (open arrow). Opacification of the right ventricle and pulmonary artery (in blue) is already interrupted. Rapid and drastic decrease of contrast is shown in the aorta (in orange) with marked spasm of visceral arteries; b: maximum intensity projection CTA image of the thorax, abdomen and pelvis in sagittal plane illustrates marked pooling of contrast material (black arrows) in the vena cava with typical “level-sign” (arrowheads); c: CTA image of the thorax in the axial plane shows bilateral, extensive COVID-19 pneumonia and typical “level-sign” (open arrowhead) in the right auricle. Opacification of the right ventricle is interrupted in association with poor internal enhancement of left ventricle and aorta. Reflux of contrast material is visible in the coronary sinus (white arrowhead) and azygos system (black arrowhead); d: maximum intensity projection CTA image of the thorax in oblique plane shows pooling of contrast in superior vena cava (black arrow) with reflux in the coronary sinus (white arrowhead) and azygos system (black arrowhead).

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The author declares that the work described has not involved experimentation on humans.

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The author declares that this report does not contain any personal information that could lead to the identification of the patient.

Disclosure of interest

The author declares that he has no competing interest.

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This work did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

The single author attests that he meets the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.

Bruno Coulier certifies that he is the sole author, designer and editor of the manuscript.