ABSTRACT
BACKGROUND: We sought to assess the relative contribution of magnetic resonance imaging (MRI), maximum intensity projection (MIP), and source images of three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) to the diagnosis of indirect (dural) carotid-cavernous sinus fistulas (CCFs). METHODS: MRI and 3D TOF MRA were obtained in eight consecutive patients with indirect CCFs confirmed by conventional catheter angiography. Two radiologists masked to the angiographic results reviewed images retrospectively to evaluate the efficacy of MRI and 3D TOF MRA source and MIP images in the diagnosis of CCF. RESULTS: MRI disclosed CCF in five of eight cases; MIP images of TOF MRA disclosed CCF in four cases; source images of TOF MRA disclosed all eight CCF cases. CONCLUSIONS: The MRA source images are indispensable for a confirmatory diagnosis of indirect (dural) CCF. Underdiagnosis may occur by relying on MRI or 3D TOF MIP images alone.
Subject(s)
Carotid-Cavernous Sinus Fistula/pathology , Imaging, Three-Dimensional/methods , Magnetic Resonance Angiography/methods , Adult , Aged , Aged, 80 and over , Cerebral Angiography/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Sensitivity and SpecificityABSTRACT
A nine-year-old girl who developed life threatening hemobilia after blunt abdominal trauma was successfully managed by embolization of the hepatic artery aneurysm. However, biliary fistula persisted and subcapsular liver abscess occurred after the endoscopic sphincterotomy and the placement of a nasobiliary drain for bile leakage. Debridement of the abscess and insertion of a drain tube eventually cured the event. The relevant literature is reviewed and the management of the hemobilia is discussed.
