Striking case of aortoesophageal fistula detected on a CTPA study, caused by a nonmalignant ulcer (confirmed later by EGD). The patient presented with hematemesis, and acute pulmonary embolus was suspected. In this case, the patient rapidly declined and coded in the ED following CT, and underwent urgent TEVAR by vascular surgery. 

It is essential for the radiologist to know which service should intervene on vascular emergencies, and to ensure that the correct service is contacted immediately to intervene. In a busy ED with varying levels of expertise and familiarity with uncommon diagnoses, it may take directly stating that this finding is life-threatening and requires urgent intervention in order to properly convey the importance of prompt action. 

While this did not happen in this case, consulting the wrong service (such as gastroenterology or cardiothoracic surgery) could result in a delay in treatment and patient morbidity as that team evaluates the patient and realizes the wrong service has been consulted.