Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

Objective: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. Materials and Methods: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. Results: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. Conclusion: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.

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Abstract No. 380 Comparing contrast exposure to patients that underwent computed tomography angiography, 99mtechnetium-labeled red blood cell scintigraphy, and catheter angiography in gastrointestinal bleeding

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.12.441 ◽

2020 ◽

Vol 31 (3) ◽

pp. S171-S172

Author(s):

L. Delbono ◽

R. Abboud ◽

N. Cypro ◽

C. Mills ◽

J. Regan ◽

...

Keyword(s):

Computed Tomography ◽

Blood Cell ◽

Gastrointestinal Bleeding ◽

Red Blood Cell ◽

Computed Tomography Angiography ◽

Catheter Angiography ◽

Contrast Exposure

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Abstract No. 392 Initial institutional evaluation of timeliness impact on catheter angiography following computed tomography angiography and 99m technetium-labeled red blood cell scintigraphy for gastrointestinal bleeding

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.12.453 ◽

2020 ◽

Vol 31 (3) ◽

pp. S176-S177

Author(s):

L. Delbono ◽

R. Abboud ◽

N. Cypro ◽

C. Mills ◽

J. Regan ◽

...

Keyword(s):

Computed Tomography ◽

Blood Cell ◽

Gastrointestinal Bleeding ◽

Red Blood Cell ◽

Computed Tomography Angiography ◽

Catheter Angiography ◽

Institutional Evaluation

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Case Report: Duodenoscopy diagnosis of a secondary aorto-duodenal fistula: A case report and review of literature.

F1000Research ◽

10.12688/f1000research.54599.1 ◽

2021 ◽

Vol 10 ◽

pp. 594

Author(s):

Hanen Elloumi ◽

Melek Ben Mrad ◽

Imen Ganzoui ◽

Sonia Ben Hamida ◽

Wissem Triki ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Gastrointestinal Bleeding ◽

Case Reports ◽

Clinical Signs ◽

Prosthetic Graft ◽

Enteric Fistula ◽

Prosthetic Reconstruction ◽

Life Threatening ◽

Computed Tomography Angiogram

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

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A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia

Case Reports in Vascular Medicine ◽

10.1155/2021/9002143 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Muhammad Adeel Samad ◽

Dhaval Patel ◽

Martin Asplund ◽

Diane C. Shih-Della Penna ◽

Yaseen Tomhe

Keyword(s):

Computed Tomography ◽

Gastrointestinal Bleeding ◽

Candida Glabrata ◽

Rare Complication ◽

Bypass Graft ◽

Graft Infection ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Graft ◽

Aortobifemoral Bypass ◽

Computed Tomography Angiogram

Background. An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000–11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass. Conclusion. Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision.

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An Unusual Case of Gastrointestinal Bleeding

Case Reports in Pediatrics ◽

10.1155/2011/748543 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Kristin N. Fiorino ◽

Brian Lestini ◽

Kim E. Nichols ◽

Sudha A. Anupindi ◽

Asim Maqbool

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Gastrointestinal Bleeding ◽

Unusual Case ◽

Abdominal Mass ◽

Abdominal Ultrasound ◽

Gi Bleeding ◽

History Of ◽

Computed Tomography Angiogram ◽

Mibg Scan

A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA), which showed an 8 cm well-defined retroperitoneal vascular mass.123Iodine metaiodobenzylguanidine (123MIBG) scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI) bleeding and highlights the utility of CTA and123MIBG in evaluation and treatment.

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18F-Fluciclovine Positron Emission Tomography in Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11020304 ◽

2021 ◽

Vol 11 (2) ◽

pp. 304

Author(s):

Giuseppina Biscontini ◽

Cinzia Romagnolo ◽

Chiara Cottignoli ◽

Andrea Palucci ◽

Fabio Massimo Fringuelli ◽

...

Keyword(s):

Prostate Cancer ◽

Computed Tomography ◽

Positron Emission Tomography ◽

Meta Analysis ◽

False Negative ◽

Final Analysis ◽

Emission Tomography ◽

True Negative ◽

Positron Emission ◽

Pet Ct

Background: to explore the diagnostic accuracy of 18F-Fluciclovine positron-emission tomography (PET) in prostate cancer (PCa), considering both primary staging prior to radical therapy, biochemical recurrence, and advanced setting. Methods: A systematic web search through Embase and Medline was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies performed from 2011 to 2020 were evaluated. The terms used were “PET” or “positron emission tomography” or “positron emission tomography/computed tomography” or “PET/CT” or “positron emission tomography-computed tomography” or “PET-CT” and “Fluciclovine” or “FACBC” and “prostatic neoplasms” or “prostate cancer” or “prostate carcinoma”. Only studies reporting about true positive (TP), true negative (TN), false positive (FP) and false negative (FN) findings of 18F-fluciclovine PET were considered eligible. Results: Fifteen out of 283 studies, and 697 patients, were included in the final analysis. The pooled sensitivity for 18F-Fluciclovine PET/CT for diagnosis of primary PCa was 0.83 (95% CI: 0.80–0.86), the specificity of 0.77 (95% CI: 0.74–0.80). The pooled sensitivity for preoperative LN staging was 0.57 (95% CI: 0.39–0.73) and specificity of 0.99 (95% CI: 0.94–1.00). The pooled sensitivity for the overall detection of recurrence in relapsed patients was 0.68 (95% CI: 0.63–0.73), and specificity of 0.68 (95% CI: 0.60–0.75). Conclusion: This meta-analysis showed promising results in term of sensitivity and specificity for 18F-Fluciclovine PET/CT to stage the primary lesion and in the assessment of nodal metastases, and for the detection of PCa locations in the recurrent setting. However, the limited number of studies and the broad heterogeneity in the selected cohorts and in different investigation protocols are limitation affecting the strength of these results.

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Improvement of the Diagnosis of Isoattenuating Pancreatic Carcinomas by Defining their Characteristics on Contrast Enhanced Computed Tomography and Endosonography with Fine-Needle Aspiration (EUS-FNA)

Diagnostics ◽

10.3390/diagnostics11050776 ◽

2021 ◽

Vol 11 (5) ◽

pp. 776

Author(s):

Robert Psar ◽

Ondrej Urban ◽

Marie Cerna ◽

Tomas Rohan ◽

Martin Hill

Keyword(s):

Computed Tomography ◽

Pancreatic Cancer ◽

Pancreatic Duct ◽

Fine Needle Aspiration ◽

Pancreatic Head ◽

Needle Aspiration ◽

Characteristic Analysis ◽

Fine Needle ◽

Contrast Enhanced ◽

Secondary Signs

(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA.

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