title: Visualization and monitoring of acute epistaxis during endovascular treatment using a flat detector CT.
abstract: BACKGROUND
  Epistaxis is one of the most common emergencies of ENT surgery and can be managed conservatively in most cases. However, transarterial embolization is an accepted treatment option for intractable epistaxis, if conservative management fails. But often, direct detection of the bleeding point by obvious contrast extravasation is not possible in conventional subtracted angiographic series (DSA). Then the suspected bleeding point is treated by endovascular embolization based on the clinical suspicion.
  
  
  METHODS
  We here present the case of a young woman with intractable epistaxis where hemorrhage with contrast extravasation was only faintly visible. We used the new imaging modality of flat detector computed tomography (FD-CT) to visualize acute hemorrhage and treatment effect accurately.
  
  
  CONCLUSIONS
  FD-CT was helpful to visualize both irregular branches of the bleeding mucosa and active hemorrhage and also to monitor an effective embolization within the angio suite. Acquisition of FD-CT imaging in addition to conventional 2-D imaging with the same system enhances the possibility to a better understanding of the individual patient's anatomy and could be beneficial in the accurate depiction of active bleeding, and it might also improve surgical management, if endovascular attempts should fail.
authors.affiliation: Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany. Sabine.Ott@uk-erlangen.de
authors.forename: S
authors.initials: S
authors.lastname: Ott
authors.forename: T
authors.initials: T
authors.lastname: Struffert
authors.forename: V
authors.initials: V
authors.lastname: Hertel
authors.forename: T
authors.initials: T
authors.lastname: Engelhorn
authors.forename: P
authors.initials: P
authors.lastname: Gölitz
authors.forename: V
authors.initials: V
authors.lastname: Arlt
authors.forename: A
authors.initials: A
authors.lastname: Dörfler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D004844:Epistaxis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome