Fig. 8

Asystole with no cardiac output. Patient with cardiac arrest at the time of CTA for acute aortic syndrome. Axial CTA at the level of the carina (a) shows no opacification of pulmonary artery, ventricles, or aorta. The CT technician subsequently called the radiologist to check the images and ask for a repeat injection after identifying abnormal contrast enhancement. Review of the axial images in the upper abdomen (b) reveal contrast reflux into IVC, dependent hepatic veins, and a blood-contrast level in the IVC. Contrast opacifies the right portal vein secondary to backflow from hepatic vein into portal vein. Contrast opacification is of the dependent vasculature only. This prompted initiation of cardiopulmonary resuscitation and calling the code team. See also Movie 1