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All right, moving on to our next section, which is trauma.

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So trauma can manifest in many different ways on a CT

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angiogram, and a CTA facilitates prompt

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evaluation in both blunt and penetrating trauma settings.

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A non-contrast acquisition can be helpful, especially in gunshot

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injuries, to distinguish bullet fragments and bone fragments

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from active contrast extravasation or material to look

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at surgical material versus active leads and allowing

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confident distinction between all of these.

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Now, typically, these also need a venous delay for comprehensive evaluation

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because you also want to look at venous structures and venous involvement in the

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trauma burden, but also to look at active extravasation and pooling of

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contrast. There are different manifestations of

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trauma, and you can have vessels and their

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branches around fracture sites that might be injured.

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You want to make sure we don't over call bleed when there might just be an early

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venous enhancement, so looking at appropriate scans and

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timing is really helpful. One of the manifestations is

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pseudoaneurysms, which are false aneurysms that result from vascular

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insults, such as trauma or surgery, where

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extravascular blood is basically just contained between the

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adventitia or surrounding tissue and hematoma, and all three layers of

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a vessel wall don't exist. Important to assess if

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there's an active bleed. So the change in morphology between the arterial and

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venous phase is what helps us distinguish between a pseudoaneurysm and a

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bleed. From an endovascular standpoint as well, CTA provides

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a role because if we assess whether there's suitability of minimally

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invasive treatments, such as just a graded compression or an ultrasound-guided

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thrombus injection versus needing a more endovascular or an

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open repair, looking at that neck of the pseudoaneurysm and the size of

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the pseudoaneurysm. Vascular injury might also lead

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to a dissection, and that just looks like

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a dissection flap like it would in any other part of the body, because there can

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be an injury between the intimal and the medial layers.

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It can result in occlusion and transaction of vessels.

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It can also result in an abnormal communication between arteries and

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veins, leading to an arteriovenous fistula.