43 yo male with history of lymphoma and poor medical compliance presented with shortness of breath and dark stools. Hemoglobin came back at 3.0 mg/dL.
Conventional CT shows complex fistula in LUQ involving spleen, stomach and colon. On spctral analysis, virtual non-contrast image shows increased contrast between myocardium and blood pool, consistent with anemia.
Ill-defined density in the posterior aspect of the fistula shows clear iodine uptake and is consistent with active GI bleed. Patient was stabilized and taken to the operating room, with extensive surgery confirming B-cell lymphoma.