Fig. 10
A 63-year-old, haemodynamically unstable (blood pressure 70/40 mmHg) female with massive haemoptysis (haemoglobin 5 g/dl) underwent CT-angiography following inconclusive endoscopy. Precontrast images (a) showed bloody fluid (+) in the stomach. Arterial-phase images (a) and Maximum-intensity projection (MIP, b) reconstructions revealed a focal contrast “blush” extravasation within the duodenal lumen (arrowheads) originating from the gastroduodenal artery (GDA). Angiography (d) and selective angiography (e) confirmed active bleeding from the GDA. Despite coil embolisation of the GDA (f) having obtained apparent exclusion of haemorrhage, angiography of the superior mesenteric artery (g) showed refilled bleeding through a branch of the arc of Buhler. Finally, after repeated embolisation on that second vessel, angiography (h) showed complete resolution of haemorrhage