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Review
. 2010 May 14;16(18):2314-6.
doi: 10.3748/wjg.v16.i18.2314.

Radiological diagnosis of duodenocaval fistula: a case report and literature review

Yong Guo  1 , Yan-Qun Zhang, Wei Lin
Affiliations
Review

Radiological diagnosis of duodenocaval fistula: a case report and literature review

Yong Guo et al. World J Gastroenterol. .

Abstract

Duodenocaval fistula (DCF) is an uncommon but lethal clinical entity. The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy. In this case report, we describe a patient with a series of computed tomography (CT) examinations over a 2-mo period in hospital. A low-density air bubble appeared in the inferior vena cava (IVC) on the second day in hospital and became clear on day 19, and gradually enlarged. Magnetic resonance imaging (MRI) also clearly demonstrated a high-signal enteric contrast medium or thrombus and signal-void air bubbles in the IVC. However, cavography did not show the filling defect. We suggest that noninvasive CT and MRI should be chosen as a first-line investigation, and IVC, including the surrounding structures, should be carefully reviewed on images if DCF is clinically considered.

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Figures

Figure 1
Figure 1
During the 2-mo hospital stay, a small, low-density air bubble appeared in the inferior vena cava (IVC) and gradually enlarged on follow-up computed tomography (CT) scans. Enteric contrast medium leaked into the IVC. Magnetic resonance imaging (MRI) clearly demonstrated the high-signal enteric contrast medium or thrombus and signal-void air bubbles. Cavography did not reveal the thrombus in the IVC. A: CT scan on the second hospital day. A low-density dot loomed up in the IVC (arrow). A mass in the right side adrenal gland was also seen; B: CT scan on the 19th hospital day. The low-density dot became more evident; C, D: CT scan on the 59th and 67th hospital day. The low-density dot (air bubble) was gradually enlarged; E: CT scan on the 73rd hospital day with water-soluble enteric contrast demonstrated air bubble surrounded by contrast medium in the IVC; F: MRI T2WI on the 74th hospital day demonstrated the high signal enteric contrast medium or thrombus and signal void air bubble in the IVC; G: Inferior vena cavogram on the 75th hospital day showed no evident thrombus in the IVC.
See this image and copyright information in PMC

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