PMC6005793_01
Selected PET-CT images showing the metastatic right sided para-aortic lymphadenopathy that was targeted by external beam irradiation. This is involving the right ureter with resulting right sided hydroureteronephrosis, as seen in the coronal PET image.
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Further enhanced uptake was confirmed by another PET Scan two months prior to admission (Fig. 1).
Selected arterial phase axial CT image showing large volume active extravasation of contrast in a distended duodenum (red arrow). Blood products are seen in the visible loops of small bowel. A collection with bubbles of gas is seen between the duodenum and aorta (blue arrow).
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Although washout of this clot was attempted, fresh blood continued to pool in the D2 (Fig. 2).
Digital subtraction angiography showing a fistula between the medial aspect of the second/third portion of the duodenum and the superior portion of the right common iliac artery just below the level of the aortic bifurcation (red arrow). The pigtail tip of angiographic catheter can be seen just above the aortic bifurcation (blue arrow).
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The initial angiogram showed bleeding through a fistula between the right common iliac artery and second to third portion of the duodenum (Fig. 3).
Application of a 10 mm wide 5.8 cm long covered stent-graft.
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A 10 mm wide and 5.8 cm long covered stent was deployed in the right common iliac artery by a consultant interventional radiologist (Fig. 4).
Fistula was successfully closed while preserving patency of the aorta and right common, internal, and external iliac arteries.
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Control angiography showed no evidence of residual haemorrhage (Fig. 5).