PMC4900022_01
Gastrointestinal bleeding scan demonstrates a focal area of moderately increased tracer concentration in the right lower quadrant of the abdomen that appears immediately in the imaging sequence and does not change in location throughout the entirety of the study. These findings could represent a bleed in the cecum or (less likely) the small bowel. An alternate explanation for the focus of persistent radiotracer concentration in the right lower quadrant is the presence of a large vascular aneurysm.
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The scintigraphic images demonstrated a focal area of moderately increased tracer concentration in the right lower quadrant of the abdomen that was present at the initiation of the imaging sequence and did not change in location throughout the entirety of the study (Fig. 1).
Angiogram after injection of the superior mesenteric artery demonstrates no evidence of extravasation or arterial lesion (left). However, the venous phase of the injection (right) demonstrates large varices (white arrow) isolated to the right lower quadrant, corresponding to the finding of persistent radiotracer in the right lower quadrant on the bleeding scan.
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Injection of the superior mesenteric artery revealed numerous large, dilated venous structures in the right lower quadrant of the abdomen, consistent with varices (Fig. 2).
Coronal view (left) from CT scan of the abdomen and pelvis with oral and intravenous contrast demonstrates massive varices in the right lower quadrant of the abdomen (white arrow). Axial view (right) demonstrates a cirrhotic liver (nodular contour, prominent caudate lobe, and heterogeneous attenuation pattern) and splenomegaly.
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In addition, the spleen was enlarged, and extensive varices in the right lower quadrant of the abdomen were again noted (Fig. 3).