Life-threatening Spontaneous Retroperitoneal Haemorrhage:Role of Multidetector CT-angiography for the Emergency Management

Objective To evaluate the role of multidetector computed tomography-angiography(MDCTA) for management of life-threatening spontaneous retroperitoneal haemorrhage(SRH).Methods A retrospective analysis of the medical records of all SRH patients admitted to our hospital from January 1,2005 to November 31,2014 was performed.SRH was defined as unrelated to invasive procedures,surgery,trauma,abdominal tumor or aortic aneurysm.Life-threatening SRH was defined as hemodynamic instability with hypotension.Sixteen cases met the inclusive criteria.Patients' characteristics,clinical presentation,imaging of MDCTA,treatment modalities,morbidity,and follow-up data were analyzed.Results The group of 16 patients included 11 men and 5 women,with a mean age of 51.5 ± 16.4years.All patients underwent MDCTA scan examinations,and active contrast media(CM) extravasation were found in 9 patients.Angiography was performed for 8 patients in the CM extravasation group.Bleeding vessels were found in 7 patients who underwent successful embolization.One patient in the CM extravasation group did not undergo angiography and died of bleeding.Seven patients without active CM extravasation underwent conservative management.Bleeding was controlled for all these 7 patients,and 1 patient died of multiple organ failure.Fourteen patients survived from SRH were successfully discharged.One patient died of heart failure during follow-up.Conclusion MDCTA was useful in the diagnosis of SRH and proved to be predictive for the outcome of conservative treatment and early intervention.

A case with insulinoma localized by combined use of various means

A patient with insulinoma diagnosed by clinical features and localized preoperatively using a combination of contrast-enhanced ultrasonography （CEUS）, dual phase contrast enhanced spiral computed tomography （DPSCT） and arterial stimulation and venous sampling （ASVS） was reported. A 37-year-old man was admitted to our hospital because of hypoglycemic attacks, palpitations, and muscular weakness. Fajans＇ ratio reported to be an index for insulinoma was positive. Transabdominal computed tomography and ultrasonography failed to detect any abnormalities. CEUS showed a small low echoic lesion in the pancreatic body with blood flow and the early arterial phase of DPSCT revealed a small strengthening focus, which mimicked a pancreatic tumor in the pancreatic body. ASVS showed that the insulin levels in the hepatic vein were extremely increased by calcium injection to the gastroduodenal artery. An open intra-abdominal operation was performed and an insulinoma was confirmed in the pancreatic body. Enucleation of tumor was undertaken and histopathological examination showed an adenoma, insulin expression was positive in immunofluorescence staining.Symptomatic hypoglycemia never happened even without glucose infusion since the operation. His blood glucose level improved to within the normal range.