Endovascular therapy using flow diversion for giant internal carotid artery pseudoaneurysm arising in the setting of an invasive pituitary macroadenoma.

This report illustrates the unusual occurrence of a pseudoaneurysm arising in the setting of a skull base mass and describes the first reported use of endovascular flow diversion therapy in such a setting. A 63-year-old man with occasional headaches during the preceding month presented with the acute onset of severe left retroorbital headache and oculomotor nerve palsy. Computed tomography (CT) and CT angiogram revealed a destructive skull base mass with an associated giant probable pseudoaneurysm of the cavernous segment of the left internal carotid artery. The patient underwent endoscopic transsphenoidal biopsy with a subsequent diagnosis of prolactinoma. Endovascular therapy utilizing two Pipeline™ flow diversion embolization devices was performed with subsequent resolution of the patient's headache and improvement in his cranial nerve deficits/cavernous sinus syndrome.

Delayed 99mTc-labeled erythrocyte scintigraphy in patients with lower gastrointestinal tract hemorrhage: effect of positive findings on clinical management.

RATIONALE AND OBJECTIVES: This study was performed to determine whether the results of delayed technetium 99m (99mTc)-labeled erythrocyte scintigraphy for lower gastrointestinal tract hemorrhage resulted in different clinical management and outcome from that in cases in which the results of initial scintigraphy were negative or equivocal. MATERIALS AND METHODS: The authors retrospectively reviewed all 398 99mTc-labeled erythrocyte scintigraphic studies obtained emergently for lower gastrointestinal tract hemorrhage at their institution between January 1, 1994, and December 7, 2001. Of 67 patients who underwent delayed studies, 37 had positive findings (average delay, 18.4 hours; range, 6-25 hours) and 30 had negative findings (average delay, 20.1 hours; range, 8-26 hours). Clinical management and outcome were compared between these two groups with respect to duration of hospitalization, volume of blood transfusion, mortality, and the percentage who were treated conservatively or referred for angiography, endoscopy, and/or surgery. RESULTS: Patients with positive delayed studies were referred more frequently for angiography than those with negative studies (35% vs 0%, P < .01). There were no significant differences between patients with positive findings and patients with negative findings with respect to mortality (8% vs 0%, P < .32), transfusion requirements (5.6 vs 3.2 units, P < .20), hospitalization (9.5 vs 6.1 days, P < .11), the percentage treated conservatively (35% vs 37%, P < .90), or the percentages referred for endoscopy (49% vs 60%, P < .50) or for surgery (24% vs 17%, P < .64). CONCLUSION: Positive findings at delayed scintigraphy resulted in increased referrals for angiography but had no other effect on clinical course or outcome of lower gastrointestinal tract hemorrhage.