It is possible to develop a new measure, based on automated segmentation of mean signal amplitude changes, of small bowel peristalsis using dynamic MR.

Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.

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We present a case of Lemierre's disease complicated by pulmonary artery pseudoaneurysm. A previously well woman aged 43 years presented with a history of a sore throat and worsening dyspnoea. She was diagnosed with a severe cavitating bilateral pneumonia complicated by internal jugular vein thrombosis consistent with a diagnosis of Lemierre's disease. She had an episode of massive haemoptysis which was confirmed to be due to a pulmonary artery pseudoaneurysm which required radiologically guided embolisation. She then required surgical decortication for bilateral empyemata. Blood cultures revealed growth of Slackia exigua, an organism yet to be linked with both of these complications concurrently. We believe this to be a novel case of this bacterium causing thrombosis and haemorrhage.

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