The Cardiac Society of Australia Summary and New Zealand, The American multisociety, and the European Society of Cardiology al have similar guidelines of indications for the use of computed tomography coronary angiography for adults These guidelines have been created in order to evaluate chest pain which cannot be attributed to otherwise known disease. These are people who are able to exercise and have not had any previous tests, people who cannot tolerate exercise and previous tests were inconclusive or people who have negative exercise test results but continue to have symptoms. CT angiography can be used to evaluate acute chest pain, whether they are associated with normal ECG and cardiac enzyme tests which are related to low-to-medium concern. The test can also be indicated in times of suspected coronary anomalies and or complex congenital heart disease. It is used to exclude CAD in new-onset heart failure and or cardiomyopathy. It is also indicated to determine CABG patency and vascular mapping before a repeated surgery or to exclude CAD before a non-coronary related cardiac surgery. Finally, the last use of CT angiography in adults is to explore the left bundle branch for a potential block for suspected CAD as an etiology .
Of 150 children studied that were admitted to the hospital with blunt head trauma, 29 were investigated with CT angiography. There were many different reasons why the child was injured and even more individual indications for the use of CT angiography. Fifty-five percent of all the patient seen presented with loss of consciousness, a total of 10.6% of the entire population studied. Other presenting symptoms included vomiting (13.8% of patients being given a CT angiogram), seizure (13.8%), bleeding (10.3%), and others .
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"Blunt Cerebrovascular Injuries (BCVI) in pediatric Traumatic Brain Injuries (TBI): SickKids experience".
Overwhelmingly, the patient underwent a CT angiography directly after a CT. Of 27 patients who had time information available, 81.5% of patients receive this test immediately after a CT scan. 2 patients actually underwent CT angiography prior to CT. The remaining three patients took the test 55 minutes, 1 hour 30 minutes, and 4 hours 36 minutes after the CT scan .
Mostly, especially due to the time frame between CT and CT angiography, it can be seen that indications for the secondary test is due to cardiovascular findings in the CT. Of the 22 patients who had information regarding the indications for the test, 54.5% involved potential damage to the carotid artery or canal. Trauma to the basilar artery was indicated in 9.1% of cases. Cases involving the sinus were also seen in 9.1% of indications. Other random indications included ruling out arteriovenous malformation, subarachnoid hemorrhage, the close proximity of occipital fracture to right jugular foramen, mastoid air cell opacification, and penetrating neck trauma .
Of the 12 tests which were done based on carotid indications, 66.7% had normal findings. One patient was found to have each of the following; a traumatic dissection of right ICA, right sigmoid sinus thrombosis, mild narrowing of RCA with possible dissection and perivascular hematoma. This final test was repeated 24 hours later and the findings were thrombosis of the left internal jugular vein in the upper neck, jugular bulb, left sigmoid sinus and lateral aspect of the left transverse sinus .
These 12 patients had a variety of outcomes and treatments. 41.6% were sent home to complete their treatment. Another 41.6% were sent to a combination of home and rehabilitation. 8.3% of patients were sent to rehabilitation only, and another 8.3% died from their trauma .
