CT and MRI features associated with shock

CT and MRI features associated with shock, and what should one do upon seeing these findings?

CT and MRI findings of shock (also known as the hypoperfusion complex) include decreased caliber of the aorta and renal arteries (related to hypovolemia and compensatory vasoconstriction); flattening of the inferior vena cava (“flat cava” sign or “slit” sign); edema surrounding the inferior vena cava (“halo” sign); decreased or absent enhancement of the spleen; heterogeneous enhancement of the liver; persistent enhancement of the kidneys (“delayed nephrogram”); decreased or absent enhancement of the kidneys (“black kidney” sign); hyperenhancement of the adrenal glands; decreased or increased pancreatic enhancement with peripancreatic edema (“shock pancreas”); and diffuse thickening of the small bowel with dilation and patchy enhancement (“shock bowel”). Other imaging findings may include hemorrhage, sometimes with active bleeding, or ascites. When one sees findings of shock on CT or MRI, one should immediately check on the patient’s condition and call for assistance from other clinical staff as needed.


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