Angiography and Therapeutic Embolisation of Bleeding Aberrant Iliac Artery Branches.

A 78-year female presented with the complain of per rectal fresh bleeding for 4 days. She was known to have diabetes and hypertension, 3 weeks back. She had an episode of left middle cerebral artery (MCA) stroke. After stroke, she suffered from upper limb weakness and aphasia. At the time of presentation, her vitals showed blood pressure of 118/52 mmHg, O2 saturation of 98%, temperature: 37°C, respiratory rate (RR) of 20/min, and heart rate (HR) of 90 bpm. After achieving hemodynamic stability, she was transferred to radiology department. Her presenting complain of active rectal bleeding was managed by interventional radiologist using angiographic embolisation. In this patient, it was found pooling of blood in a retrograde fashion in the sigmoid colon. Bleeding was initially believed to be coming from sigmoid arteries seen on images of CT scan and colonoscopy. However, arteriography showed that source of bleeding was from middle and inferior rectal arteries that originated from left internal iliac artery. The intervention radiology (IR) team had to put in extensive effort to locate and perform therapeutic embolisation.

Ultrasound in the diagnosis and management of intrauterine growth retardation.

OBJECTIVE: To evaluate the value of ultrasound in the diagnosis and management strategies of intrauterine growth retardation. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Radiology Department, Aga Khan University Hospital, Karachi, from April 1998 to August 1999. PATIENTS AND METHODS: The study population comprised of 206 subjects evaluated for suspected intrauterine growth retardation. Grey scale as well as Doppler ultrasound findings were evaluated and compared against post-natal outcome. RESULTS: One hundred and eight out of 206 subjects showed positive imaging results with 40 false positive and 20 false negative subjects. The sensitivity, specificity, positive predictive and negative predictive values were 77.8%, 66.1%, 55.6%, and 45.1% respectively. Forty subjects showed false positive results on imaging (low biophysical profile score and Grey scale biometry discrepancy) while 20 of the subjects showed false negative results (normal on US imaging) when compared with postnatal neonatal body weight criteria. Twenty-two subjects had oligohydramnios with amniotic fluid index below 5 percentile for their respective gestational ages (20%) out of 108. CONCLUSION: Obstetric and Doppler ultrasound is an accurate method for diagnosis and management of fetal growth retardation.