{
  "abstract": "A 51-year-old man was admitted due to 4 month severe epigastric pain, with a history of untreated maternal–infant transmitted hepatitis B. Laboratory tests showed normal blood count and liver function, elevated alpha-fetoprotein (AFP) of 205 ng/mL, HBsAg (+), HBcAb (+), HBeAg (−), HBeAb (−) and an HBV-DNA level of 5143 IU/mL. Ultrasound and MRI revealed a large mass in the right upper abdomen, with suspicion of gastrointestinal stromal tumour (GIST) ( figure 1A). On referral to our hospital, enhanced abdominal CT showed a 10.2 cm × 8.8 cm mass with heterogeneous enhancement and an inconspicuous fast-in/fast-out pattern, suggesting origin from antrum, compression of right liver lobe (figure 1B,C) and blood supply from gastro-duodenal artery (figure 1D). Endoscopic ultrasonography (EUS) revealed an unclear boundary between the mass and the antrum, with smooth mucosa (figure 2). EUS-guided fine needle aspiration (EUS-FNA) was taken as PET-CT showed hypermetabolism, but the patient developed severe abdominal pain, hypotension and a decrease in haemoglobin immediately after operation, with CT angiography indicating contrast extravasation in the mass and haemoperitoneum (figure 3A). Massive intra-abdominal haemorrhage was suspected, and digital subtraction angiography (DSA) showed that the mass was mainly supplied by the hepatic arteries, with successful embolisation (figure 3B).",
  "authors": [
    {
      "affiliations": [
        "Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China"
      ],
      "name": "Jia Xu"
    },
    {
      "affiliations": [
        "Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China"
      ],
      "name": "Lisha Jing"
    },
    {
      "affiliations": [
        "Department of Endocrinology, Beijing Friendship Hospital, Capital Medical College, Beijing, People's Republic of China"
      ],
      "name": "Yabing Wang"
    },
    {
      "affiliations": [
        "Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, People's Republic of China"
      ],
      "name": "Zheng Wang"
    },
    {
      "affiliations": [
        "Department of Liver Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, People's Republic of China"
      ],
      "name": "Jin Bian"
    },
    {
      "affiliations": [
        "Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China"
      ],
      "name": "Zhiwei Wang"
    },
    {
      "affiliations": [
        "Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China"
      ],
      "name": "Xuan Wang"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China"
      ],
      "name": "Kun He"
    }
  ],
  "title": "What DSA can do: rethinking from fatal intra-abdominal haemorrhage after EUS-FNA for a large abdominal mass",
  "uid": "55553f67-6792-55ba-9712-284628916fb0"
}