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CT enterography (CTE) is sensitive and specific for active inflammatory changes of Crohn disease (CD), but its use has been limited by exposure to ionizing radiation. The objective of this study is to show the noninferiority of a model-based iterative reconstruction (MBIR) technique using lower radiation doses compared with standard-dose CTE in the assessment of CD.Patients referred to a hospital radiology department for CTE for the evaluation of CD underwent both a standard examination (used to generate filtered back-projection and adaptive statistical iterative reconstruction [ASIR] images) and low-dose MBIR CTE performed in a random sequence on the same day. Images were reviewed by two radiologists for signs of small-bowel CD. Radiologic findings obtained using ASIR and clinical assessments of disease activity served as the reference standard for comparison with low-dose CTE findings.A total of 163 patients, 92 (56.4%) of whom had active disease, underwent CTE. MBIR was found to be noninferior to the two standard-dose techniques, with no significant differences noted between the three types of images when compared with the clinical reference standard. As compared with the radiologic standard of ASIR, the very-low-dose scans had a high degree of accuracy, with sensitivity ranging from 0.85 to 0.94 and specificity ranging from 0.84 to 0.97 depending on the reader. A significant reduction in radiation exposure was noted with MBIR (mean [± SD] reduction, 3.30 ± 3.17 mSv) versus standard-dose imaging (7.16 ± 4.61 mSv; p0.001).Low-dose CTE using MBIR is sensitive and specific for the detection of active inflammatory changes of CD while utilizing radiation doses substantially lower than those associated with standard techniques.

BACKGROUND: Crohn’s disease (CD) is a condition that affects young individuals. Clinically assessed disease activity by a Gastroenterologist is the gold standard for identifying patients with active inflammation and relapse. Fecal Calprotectin (FC) is a biomarker that is an independent indicator of active inflammation. Bressler et al has shown that FC levels 250 µg/g strongly predict active inflammation/relapse. FC levels between 100–250 µg/g is an indeterminate zone that warrants further testing to confirm the presence/absence of disease. Computed tomography enterography (CTE) is a proposed next test. Recent research has shown that low-dose CTE using model-based iterative reconstruction (MBIR) is non-inferior to standard dose CTE for identifying signs of small bowel inflammation. AIMS: To assess the utility of MBIR CTE signs, in patients with intermediate FC levels, for predicting those who would have active inflammation on clinical assesment. METHODS: A single-center, retrospective cohort study of 163 patients subjected to clinical assessment, FC measurement and low dose CTE to evaluate CD activity between November 2012 & February 2015. The CTE studies for each patient were reviewed by two radiologists for radiographic findings of small bowel CD inflammation. Clinically assessed disease activity by a Gastroenterologist served as the reference standard. Multivariate logistic regression was used to build a scoring equation based on FC levels & radiographic signs to predict active disease in the reference standard. RESULTS: Of the 163 patients, 92 (56%) patients had active inflammation based on clinical assessment. Sixty-five (71%) of the 92 patients clinically diagnosed with active inflammation also had CTE that was deemed active by overall radiologist impression. Fifty (70%) of the 71 patients clinically diagnosed with inactive inflammation also had CTE that was deemed inactive by overall radiologist impression. Sensitivity, specificity, PPV & NPV of overall radiologic impression for CD activity was 0.70, 0.71, 0.75, 0.65, respectively. 138 patients had measured FC levels. Seventy-eight (57%) had clinically active disease & 60 (43%) had clinically inactive disease. In those with active disease, 16 (20%), 13(17%) & 49(63%) had FC levels 250 µg/g, respectively. In those with inactive disease, 53 (88%), 7(12%) & 0(0%) had FC levels 250 µg/g, respectively. An equation based on mural stratification & FC level predicted active disease the best. This equation had a sensitivity, specificity, PPV, NPV & accuracy of 0.82, 0.90, 0.91, 0.79 & 0.85, respectively. CONCLUSIONS: In patients with FC levels between 101–250, MBIR CTE is a reasonable further test to confirm the presence/absence of disease FUNDING AGENCIES: None

Importance Chemoradiotherapy (CRT), followed by surgery, is the recommended approach for stage II and III rectal cancer. While CRT decreases the risk of local recurrence, it does not improve survival and leads to poorer functional outcomes than surgery alone. Therefore, new approaches to better select patients for CRT are important. Objective To conduct a phase 2 study to evaluate the safety and feasibility of using magnetic resonance imaging (MRI) criteria to select patients with “good prognosis” rectal tumors for primary surgery. Design, Setting, and Participants Prospective nonrandomized phase 2 study at 12 high-volume colorectal surgery centers across Canada. From September 30, 2014, to October 21, 2016, a total of 82 patients were recruited for the study. Participants were patients newly diagnosed as having rectal cancer with MRI-predicted good prognosis rectal cancer. The MRI criteria for good prognosis tumors included distance to the mesorectal fascia greater than 1 mm; definite T2, T2/early T3, or definite T3 with less than 5 mm of extramural depth of invasion; and absent or equivocal extramural venous invasion. Interventions Patients with rectal cancer with MRI-predicted good prognosis tumors underwent primary surgery. Main Outcomes and Measures The primary outcome was the proportion of patients with a positive circumferential resection margin (CRM) rate. Assuming a 10% baseline probability of a positive CRM, a sample size of 75 was estimated to yield a 95% CI of ±6.7%. Results Eighty-two patients (74% male) participated in the study. The median age at the time of surgery was 66 years (range, 37-89 years). Based on MRI, most tumors were midrectal (65% [n = 53]), T2/early T3 (60% [n = 49]), with no suspicious lymph nodes (63% [n = 52]). On final pathology, 91% (n = 75) of tumors were T2 or greater, 29% (n = 24) were node positive, and 59% (n = 48) were stage II or III. The positive CRM rate was 4 of 82 (4.9%; 95% CI, 0.2%-9.6%). Conclusions and Relevance The use of MRI criteria to select patients with good prognosis rectal cancer for primary surgery results in a low rate of positive CRM and suggests that CRT may not be necessary for all patients with stage II and III rectal cancer. Trial Registration ISRCTN.com identifier:ISRCTN05107772

The objective was to evaluate reporting of guideline-recommended elements for thyroid ultrasound (US), and to determine whether element reporting was associated with the time to cytological and/or surgical diagnosis.US reports of adults who underwent thyroid surgery for benign (n = 106) or malignant (n = 105) thyroid nodules between 2009 and 2014 were retrospectively reviewed for inclusion of 11 elements.On average 5.1 elements of 11 (46.4%) were included in US reports of all nodules. The setting of the US (academic versus community center) also influenced the number of elements reported (6.3 in academic versus 4.9 in community, p0.001). A higher number of reported elements were significantly associated with fewer days between US and FNAB, FNAB and OR, and US and OR (p0.001, p = 0.007, and p0.001, respectively).Under-reporting of guideline-recommended US elements is associated with delayed cytological diagnosis and surgical treatment of thyroid nodules.

Purpose The objective of the study was to evaluate the performance of magnetic resonance imaging (MRI) for the diagnosis of appendicitis during pregnancy. Methods We conducted a retrospective review of all MRI scans performed at our institution, between 2006 and 2012, for the evaluation of suspected appendicitis in pregnant women. Details of the MRI scans performed were obtained from the radiology information system as well as details of any ultrasounds carried out for the same indication. Clinical and pathological data were obtained by retrospective chart review. Results The study population comprised 63 patients, and 8 patients underwent a second MRI scan during the same pregnancy. A total of 71 MRI scans were reviewed. The appendix was identified on 40 scans (56.3%). Sensitivity of MRI was 75% and specificity was 100% for the diagnosis of appendicitis in pregnant women. When cases with right lower quadrant inflammatory fat stranding or focal fluid, without appendix visualization, were classified as positive for appendicitis, MRI sensitivity increased to 81.3% but specificity decreased to 96.4%. Conclusions MRI is sensitive and highly specific for the diagnosis of appendicitis during pregnancy and should be considered as a first line imaging study for this clinical presentation.

The measurement of angles between anatomical structures is common in radiological and orthopedic practice. Frequently used measurements include scapholunate angle for assessment of wrist instability and Cobb’s angle used for assessment of scoliosis. Measurements of these angles are easily performed on plain X-ray radiographs. However, the situation is more complicated when these measurements are to be performed on cross-sectional (CT or MRI) examinations. On some of the diagnostic workstations, it is not possible to perform angle measurements between the structures if they are not identified on the same image and are located on different images of the same projection or plane. We present a simple solution to measure angles between structures on different images that can be used both in CT and MR.

OBJECTIVE. The purpose of this work was to show the radiologic signs named after weapons and munitions along with their military counterparts to help radiologists recognize these signs, which will allow confident interpretation and diagnosis.CONCLUSION. Numerous pathologic conditions have classic radiologic manifestations that resemble weapons and ammunition. Most of these signs are highly memorable and easy to recognize. However, the names of the weapons (some of them antique and some not commonly known) may confuse radiologists who are not familiar with the appearance of such weapons as the scimitar, bayonet, or dagger. The value of the signs is reduced if the radiologist is unfamiliar with the appearance of the corresponding weapon.

We continue with an article that describes the people behind eponyms in radiology. The collection of the biographical details about these people took us on a fascinating search in immigration archives and into contact with family friends and descendants of these people. This search helped to find some previously unpublished data and photographs, which made a fascinating tour to the past exciting and fruitful. We discovered that eponyms sometimes emerged as a result of a single article, which was not necessarily a significant step in the author’s career. Only a few eponyms are used in radiologic practice, unlike in the specialties of neurology or surgery. Lewicki suggested that this fact as well as the end of the eponym era a few decades ago probably paralleled other changes in medicine, with the discipline becoming more scientific and less descriptive. However, eponyms help us to remember that, even today, when our lives are so dominated by technology, advancement of knowledge still depends on people. As mentioned in the first part, we were dedicated to the names behind the exclusive eponyms of radiologic signs.

Background To retrospectively evaluate the diagnostic performance and clinical utility of magnetic resonance imaging (MRI) in pregnant patients suspected of having acute appendicitis, when an ultrasound study generated an inconclusive result. Methods The medical records of 19 consecutive women who underwent abdominal and pelvic MRI at a tertiary care referral center (St. Paul's Hospital, Vancouver, Canada), as part of the work up of clinically suspected acute appendicitis, were retrospectively reviewed. MRI was carried out when ultrasound findings were inconclusive. MRI findings were reviewed and compared with surgical findings and clinical follow-up data including pregnancy outcome. Results One of the 19 patients (5.3%) in the study cohort had an appendicitis diagnosed by MRI that was confirmed at operation and by specimen histology. The remaining study patients were diagnosed as not having appendicitis by MRI. These patients were followed until delivery, which was uneventful for all but one patient who was found to have appendicitis during Cesarean section. Overall, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for the diagnosis of appendicitis during pregnancy was 50.0%, 100%, 100%, 94.4%, and 94.7%, respectively. In three patients (16.7%) with no MRI evidence of appendicitis, MRI identified an alternative etiology for their abdominal pain (two patients diagnosed with ovarian cysts, one patient diagnosed with a uterine fibroid). Conclusions MRI represents a useful diagnostic test for acute appendicitis in pregnant women, and decreases the need for an emergency operation. Its high negative predictive value makes MRI useful for ruling out appendicitis in pregnant patients who have an inconclusive ultrasound. However, the low sensitivity observed in this study suggests that MRI, like other imaging modalities, is not perfect, and may miss an acute appendicitis diagnosis. Thus, future prospective clinical study of MRI as a diagnostic test for the evaluation of women who present with acute abdominal pain and possible appendicitis during pregnancy is warranted.

ObjectiveTo evaluate the performance of a computer-aided detection (CAD) system for diagnosis of pulmonary embolism on computed tomography (CT) pulmonary angiography.Materials and MethodsOne hundred and four pulmonary CT angiograms for pulmonary emboli (PE) were reviewed both by radiologists and a C

Uterine fibroids are common benign lesions. Other common benign masses include renal cysts, renal angiomyolipomas, hepatic cysts, hepatic hemangiomas, thyroid cysts, adrenal incidentalomas, pulmonary granulomas and hamartomas, ovarian cysts, and dermoids. All these conditions, especially in asymptomatic patients, almost never have clinical significance. However, it is important to differentiate them from more sinister or even malignant lesions. In general, when a lesion is described as a fibroid, no further evaluation is performed. So if we say that a lesion is a fibroid, we have to be sure. Endometrial fibroids may mimic endometrial polyps or endometrial cancer. Subserous, especially pedunculated fibroids, may need further evaluation to differentiate them from ovarian pathology, colonic pathology, or even müllerian duct anomalies. Pelvic magnetic resonance imaging may be helpful in these cases.

Background The objective of this study was to evaluate dual-energy computed tomography (DE-CT) for preoperative parathyroid tumor (PT) localization in individuals undergoing parathyroidectomy for treatment of primary hyperparathyroidism (PHP). Methods DE-CT was evaluated by retrospective review of the clinical and biochemical characteristics, imaging, operative findings, and outcomes for PHP cases undergoing an initial operation at a single center. Results The accuracy of each preoperative imaging test, based on operative findings and pathological confirmation of removal of a PT from the localized site was: 58% for ultrasound, 75% Tc-99m sestamibi noncontrast single photon emission noncontrast CT, and 75% for DE-CT. DE-CT was able to correctly localize a PT in a 3rd of cases that were nonlocalized. All study patients had normalization of serum calcium and parathyroid hormone levels postoperatively. Conclusions DE-CT shows promise for the preoperative PT localization, especially in nonlocalized PHP cases, and warrants further investigation.

Our objective was to evaluate the performance of a computer-aided detection (CAD) system for pulmonary nodule detection using low-dose screening CT images.One hundred fifty consecutive low-dose screening CT examinations were independently evaluated by a radiologist and a CAD pulmonary nodule detection system (R2 Technology) designed to identify nodules larger than 4 mm in maximum long-axis diameter. All discrepancies between the two techniques were reviewed by one of another two radiologists working in consensus with the initial interpreting radiologist, and a "true" nodule count was determined. Detected nodules were classified by size, density, and location. The performance of the initial radiologist and the CAD system were compared.The radiologist detected 518 nodules and the CAD system, 934 nodules. Of the 1,106 separate nodules detected using the two techniques, 628 were classified as true nodules on consensus review. Of the true nodules present, the radiologist detected 518 (82%) of 628 nodules and the CAD, 456 (73%) of 628 nodules. All 518 radiologist-detected nodules were true nodules, and 456 (49%) of 934 of CAD-detected nodules were true nodules. The radiologist missed 110 true nodules that were only detected by CAD. In six patients, these were the only nodules detected in the examination, changing the imaging follow-up protocol. CAD identified 478 lesions that on consensus review were false-positive nodules, a rate of 3.19 (478/150) per patient.CAD detected 72.6% of true nodules and detected nodules in six (4%) patients not identified by radiologists, changing the imaging follow-up protocol of these subjects. In this study, the combined review of low-dose CT scans by both the radiologist and CAD was necessary to identify all nodules.

AIM: To evaluate the effect of experience on the accuracy rate of computed tomography colonography (CTC) interpretation and patient preferences/satisfaction for CTC and colonoscopy. METHODS: A prospective, non-randomized, observational study performed in a single, tertiary care center involving 90 adults who underwent CTC followed by colonoscopy on the same day. CTC was interpreted by an abdominal imaging radiologist and then a colonoscopy was performed utilizing segmental un-blinding and re-examination as required. A radiology resident and two gastroenterology (GI) fellows blinded to the results also interpreted the CTC datasets independently. Accuracy rates and trend changes were determined for each reader to assess for a learning curve. RESULTS: Among 90 patients (57% male) aged 55 ± 8.9 years, 39 polyps ≥ 6 mm were detected in 20 patients and 13 polyps > 9 mm in 10 patients. Accuracy rates were 88.9% (≥ 6 mm) and 93.3% (> 9 mm) for the GI Radiologist, 89.8% (≥ 6 mm) and 98.9% (> 9 mm) for the Radiology Resident and 86.7% and 95.6% (≥ 6 mm) and 87.8% and 94.4% (> 9 mm) for each of the GI fellows respectively. The reader’s accuracy rate did not change significantly with the percentage change rate ranging between -1.7 to 0.9 (P = 0.12 to 0.56). Patients considered colonoscopy more satisfactory than CTC (30% vs 4%, P < 0.0001), they felt less anxiety during colonoscopy (36% vs 7%, P < 0.0001), they experienced less pain or discomfort during colonoscopy compared to CTC (69% vs 4%, P < 0.0001) and colonoscopy was preferred by 77% of the participants as a repeat screening test for the future. CONCLUSION: No statistically significant learning curve was identified in CTC interpretation suggesting that further study is required to identify the necessary training to adequately interpret CTC scans.

It is commonly believed that the revenues from the selling of the Beatles' records by Electric and Musical Industries (EMI) allowed the company to develop the computed tomography (CT) scanner. Some went to define this as the Beatles' gift to medicine. However, significant controversies and discrepancies arise from analysis of this statement, making its correctness doubtful. The details of financing required for the CT development and the part of EMI in financial input have never been publicly announced. This work analyzes the financial contributions to the CT development and investigates if the revenues received from the sales of the Beatles' records were used for the creation of the CT scanner. Timeline of the development of the EMI CT scanner and the financial inputs of EMI and British Department of Health and Social Security (DHSS) were assessed. Without salary expenses to Godfrey Hounsfield and his team, the development of the CT scanner cost EMI approximately £100,000. The British DHSS's expenses were £606,000. Hence, the financial contribution of DHSS into the development of the CT scanner was significantly bigger than that of EMI. Accordingly, British tax payers and officials of British DHSS are to be thanked for the CT scanner. The Beatles' input into the world's culture is valuable and does not require decoration by nonexistent connection to the development of CT. A positive aspect to this misconception is that it keeps in public memory the name of the company that developed the CT scanner.

Mineral foreign bodies (stones) are infrequent findings in clinical and radiological practice. However, a growing number of reports indicate that they raise clinical and diagnostic concern in ophthalmology, neurosurgery, maxillofacial surgery, otolaryngology, gastroenterology, and vascular surgery. Dense finding in the soft tissue without clear history of foreign body penetration may represent diagnostic challenge mimicking calcifications or bony fragments. The aim of this work is to analyze the appearance of stone foreign bodies on radiographs and computed tomography. A collection of minerals and rocks was used for analysis. The clinical case of a stony foreign body which penetrated into the soft tissue of the leg is used to demonstrate the diagnostic challenge and management. Available literature describing imaging characteristics of stones was reviewed. The results of this work will help in diagnostic interpretation and assessment of stone foreign body composition.

Disk displacement frequently causes dysfunction of the temporomandibular joint (TMJ). Magnetic resonance imaging (MRI) of the TMJ is 95% accurate in the assessment of disk position and form. Various restorative procedures are used for treatment of disk displacement. However, several authors have noted a lack of correlation between MRI findings of disk displacement and the extent of pain and dysfunction of the TMJ. The purpose of this study was to evaluate whether MRI findings of various degrees of disk displacement could be correlated with the presence of clinical signs and symptoms in patients with a clinical disorder of the TMJ.One hundred and forty-four TMJs (in 72 patients) were imaged. Displacement of the posterior band in relation to the condyle was quantified as mild or significant.Disk displacement was found in 45 (54%) of the 84 symptomatic joints and 13 (22%) of the 60 asymptomatic joints. Among the 84 symptomatic joints, 31 (37%) had disk displacement with reduction and 14 (17%) had disk displacement without reduction. In the latter group, 11 (79%) of the 14 joints had significant displacement of the posterior band (8 or 9 o'clock) and 21% had mild displacement of the posterior band (10 o'clock). Of the 60 clinically asymptomatic joints, 47 (78%) had no signs of disk displacement on MRI, whereas 13 (22%) had disk displacement with reduction. None of the asymptomatic joints had disk displacement without reduction. The difference in occurrence of disk displacement between symptomatic and asymptomatic joints was statistically significant (54% vs. 22%; p0.001). However, the difference in occurrence of disk displacement with reduction of the disk on mouth opening was not statistically significant (37% vs. 22%; p = 0.06).Disk displacement on MRI correlated well with clinical symptoms in cases of significant disk displacement and in cases of disk displacement without reduction. When disk displacement with reduction was mild, there was no statistically significant difference between symptomatic and asymptomatic joints, which suggests that other causes should be considered.

The purpose of this study was to describe the thoracic radiologic findings of chronic granulomatous disease in adults.We retrospectively analyzed the chest radiographic and CT findings in four adults with chronic granulomatous disease during five episodes of lower respiratory tract infection.Chest radiographic findings included areas of consolidation (60%), diffuse reticulonodular opacities (40%), pleural effusion (20%), and pulmonary artery enlargement (20%). CT findings included areas of consolidation (60%), pulmonary nodules in a random distribution (60%), centrilobular nodules (60%), tree-in-bud opacities (40%), areas of scarring and traction bronchiectasis (100%), emphysematous changes (75%), areas of decreased attenuation and vascularity associated with air trapping on expiratory CT (50%), mediastinal and/or hilar lymphadenopathy (60%), pulmonary artery enlargement (50%), and pleural effusion (20%). Areas of consolidation and nodules were the most prominent findings and at histologic examination were found to be associated with infection or granulomatous inflammation.The pulmonary radiologic findings of chronic granulomatous disease include consolidation, nodules, areas of scarring, traction bronchiectasis, emphysema, air trapping, mediastinal and hilar lymphadenopathy, pulmonary artery enlargement, and pleural effusion.

The evaluation of articular cartilage currently relies primarily on the identification of morphological alterations of the articular cartilage. Unlike anatomic imaging, T2 mapping is sensitive to changes in the chemical composition and structure of the cartilage. Clinical evaluation of T2 mapping of the glenohumeral joint has not been previously reported. The objectives of this study were to evaluate the feasibility of magnetic resonance T2 mapping of the glenohumeral joint in routine clinical imaging, to assess the normal T2 mapping appearance of the glenohumeral joint, and to compare the findings on T2 maps to conventional MR pulse sequences. Magnetic resonance imaging (MRI) examinations of 27 shoulders were performed in a routine clinical setting. All studies included acquisition of T2 mapping using a dedicated software. The T2 maps were analyzed along with the routine MR exam and correlation of cartilage appearance on T2 map and on conventional MR sequences. T2 imaging maps were obtained successfully in all patients. T2 maps and routine MRI correlated in cases of normal cartilage and prolonged T2 values and cartilage defects. In four cases, increased T2 relaxation times in the cartilage and cartilage defects were more apparent on T2 maps. Acquisition of T2 maps at the time of routine MRI scanning is feasible and not time-consuming.

Background Littoral cell angioma (LCA) is a recently described primary vascular neoplasm of the spleen that may be associated with other malignancies and may itself also have malignant potential. Case presentation We present a case of LCA that was discovered incidentally in a 52-year-old woman who presented with biliary colic at the time of consultation for cholecystectomy. This vascular neoplasm was evaluated by ultrasound, CT, MRI, Tc-99m labelled red blood cell scintigraphy, and core biopsy. A splenectomy revealed LCA by pathological evaluation. Post-operative outcome was favourable with no evidence of complication or recurrent disease. Following this case presentation, clinical, radiographic, and pathological features of LCA will be reviewed as well as recent advances in our understanding of this uncommon splenic lesion. Conclusion LCA is a rare, generally benign, primary vascular tumour of the spleen that typically is discovered incidentally. Individuals diagnosed with this tumour must be carefully evaluated to exclude primary, secondary, and synchronous malignancies.

Background & aims: Increasing evidence indicates abnormal pain processing in the central nervous system in patients with Crohn's disease (CD). The purpose of this study was to understand changes in resting-state brain activity in CD patients in remission and its relationship with abdominal pain. Methods: Twenty-five CD patients with abdominal pain, 24 CD patients without abdominal pain, and 33 healthy control subjects were scanned using a 3.0 T functional magnetic resonance imaging (fMRI) scanner. Regional Homogeneity (ReHo) was used to assess resting-state brain activity among the three groups. Daily pain scores were collected 1 week before fMRI scanning. Results: Patients with abdominal pain exhibited lower ReHo values in the insula, middle cingulate cortex (MCC), supplementary motor area, and higher ReHo value in the temporal pole, whereas patients without abdominal pain exhibited lower ReHo value in the hippocampal/parahippocampal cortex and higher ReHo value in the dorsomedial prefrontal cortex (dmPFC) (all P

To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients.Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. Femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took approximately 50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency.Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.