Primary aorto enteric fistula a rare but life threatening condition: a case report.

Primary aorto enteric fistula is a very rare but life threatening condition. We report a case of primary aorto enteric fistula in a 62-year-old man whose diagnosis was only made at laparotomy. A high index of suspicion along with a good history and physical exam is critical for making a successful diagnosis. Surgical exploration is warranted if other investigation is not conclusive.

The need for radio-opaque side markers on CT of the paranasal sinuses.

AIM: To audit the presence of a radio-opaque "side marker" routinely placed on the right side of the face of all patients undergoing computed tomography (CT) of the paranasal sinuses in our hospital and to audit awareness levels amongst ear, nose and throat (ENT) clinical and theatre staff regarding the "marker". MATERIALS AND METHODS: An audit of 100 CT studies of the paranasal sinuses was carried out with regard to the presence or absence of the marker. A further audit was conducted relating to the awareness amongst ENT clinical staff and theatre nurses regarding the marker. Re-audit of a second cohort of 100 sinus CT studies was carried out after implementing changes indicated by the first audit cycle. Awareness amongst staff concerned was similarly re-audited. RESULTS: In audit cycle I the side marker was positively identified in 85% of the CT examinations and were deemed absent in 15%. Of the clinical staff interviewed, only 30% were aware of the presence of the "marker" and it's significance. In audit cycle II the "side marker" was positively identified in 100% of the scans reviewed. Awareness of the presence of the "marker" amongst clinical staff was found to be 90%. CONCLUSIONS: The routine placement of a radio-opaque side marker on the right zygoma of all patients undergoing CT of paranasal sinuses is a simple yet effective additional means of denoting the correct side whilst interpreting such images. This has important implications regarding surgery. The audit has shown an improvement in both the placement of the side marker as well as in awareness levels amongst staff involved to ensure best practice.