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Primary aortoenteric fistulas are rare, with the annual incidence of such fistulas estimated to be 0.007 per million. The most common predisposing conditions for primary aortoenteric fistulas are atherosclerotic abdominal aortic aneurysms or penetrating atherosclerotic ulcers. We illustrate a rare case of an inflammatory aortic aneurysm causing a primary aortic fistula, with a direct fistulous jet from the aorta to the bowel with resultant catastrophic bleeding. In contrast to atherosclerotic aneurysms, most inflammatory aneurysms are symptomatic and show dense perianeurysmal fibrosis and periaortic wall thickening. A direct jet of contrast extravasation from the aorta into a bowel loop, while rarely seen, remains the most specific sign of a primary aorta-enteric fistula. A comprehensive literature review of the clinical presentation, imaging features, and differential diagnosis of a primary aortoenteric fistula are also discussed.

A 16-year-old Chinese male patient, who had a past medical history of hyperventilation complicated by carpopedal spasms, presented to the emergency department with constipation of five days' duration, colicky abdominal pain, lethargy, weakness and body aches. He was still able to pass flatus, and did not complain of vomiting, fever, chills or rigors. On examination, the abdomen was soft and non-tender. Digital rectal examination was unremarkable, as was the full blood count, except for a raised total white blood cell count of 16.6 × 10 9 /L. Renal and liver function tests and urinalysis were also unremarkable. The patient was hospitalised for further investigation of constipation. During his hospital stay, abdominal radiography was performed (Fig. 1). He subsequently desaturated acutely, and computed tomography (CT) was performed (Fig. 2)

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Background and Objectives The purpose of this study is to examine differences in image quality, discrepancy rates, productivity and user experience between remote reporting over Virtual Application (VA) using visually calibrated monitors, and reporting using diagnostic grade workstations in hospital premises. Methods Three specialist accredited radiologists examined and provisionally reported outpatient CT and MR studies over PACS delivered as a VA, using visually calibrated monitors from their homes. They then proceeded to view the same studies within hospital premises and issue a final report. Surveys were filled out for each imaging study. Discrepancies were reviewed and assigned RADPEER scores. Results A total of 51 outpatient CT and MRIs were read. Relative to hospital premise reporting, on a Likert scale of 5 (the higher the better), average image quality was 3.9, speed of loading and image manipulation was 4.4 and productivity was 4.1. Remote reporting user experience did not differ significantly between CT versus MRI studies. Complete concordance rate was 80.4% (41/51) and only one of the studies had a significant discrepancy, which may have been due to extra time given to interpretation. All three radiologists reported factors influencing image display and quality as the top factor impacting remote reporting throughput. Conclusions Remote reporting over VA with visually calibrated monitors for CT and MR can be useful in periods of staffing difficulty to augment on-site radiologists, though attention must be paid to its limitations and policies defined by local leadership with reference to relevant national position