Gastrointestinal hemorrhage from fistula between traumatic pseudoaneurysm of the right hepatic artery and the duodenum.

The evaluation of gastrointestinal hemorrhage after abdominal trauma may be both urgent and difficult. After gunshot trauma, a fistula between the duodenum and a post-traumatic, hepatic artery pseudoaneurysm presented as a gastrointestinal hemorrhage. Tc-99m labeled RBC imaging demonstrated the pseudoaneurysm but did not show it as the source of the gastrointestinal hemorrhage--a large clot had formed, occluding the fistula. Angiography further delineated the lesion as arising from the right hepatic artery and transcatheter embolization was performed.

Mycotic aneurysms in intravenous drug abusers: the utility of intravenous digital subtraction angiography.

Two-hundred thirteen intravenous digital subtraction angiographic (DSA) examinations were performed on 195 intravenous drug abusers to rule out the possibility of a mycotic aneurysm in a groin, neck, or upper extremity infection. Twenty-three surgically proved cases of mycotic aneurysm were correctly identified with no false positive results. In addition, six cases of major venous occlusion were documented. We present the results of our experience and conclude that DSA is an effective and cost-efficient method of examining this high risk patient population.