Hereditary Hemorrhagic Telangiectasia with Hepatic Vascular Malformations

The role of nuclear medicine in a case of Rendu-Osler-Weber disease with pulmonary involvement

Rendu-Osler-Weber syndrome or hereditary hemorrhagic telangiectasia (HHT) is a rare systemic disease. Its primary pathogenic expression is multiple arteriovenous malformations (AVM) and severe hypoxia. A case of suspected pulmonary embolism in a 49-year-old male with intestinal, cardiac, and pulmonary HHT affection is reported. Pulmonary AVM could create an apparent mismatch perfusion defect evident upon ventilation and perfusion scan (V/Q scan), leading to misinterpretation. It reinforces the importance between clinics, anatomy, and functional evaluation. Care must be taken when interpreting V/Q scan and the reporting physician must be alert to the possible sources of errors.

Rendu-Osler-Weber disease: a gastroenterologist's perspective

Hereditary hemorrhagic teleangectasia (HHT, or Rendu-Osler-Weber disease) is a rare inherited syndrome, characterized by arterio-venous malformations (AVMs or Telangiectasia). The most important and common manifestation is nose bleeds (epistaxis). The telangiectasias (small AVMs) are most evident on the lips, tongue, buccal mucosa, face, chest, and fingers, however; large arterio-venous malformations can also occur in the lungs, liver, pancreas, or brain. Telangiectasias in the upper gastrointestinal tract are known to occur, however data regarding possible small-bowel involvement is limited due to technical difficulties in visualizing the entire gastrointestinal tract. The occurrence of AVMs in the stomach and small bowel can result in chronic bleeding and anaemia. Less frequently, this may occur due to bleeding from oesophageal varices, as patients with HHT can develop hepatic parenchymal AVMs or vascular shunts which cause hepatic cirrhosis and portal hypertension. Gastroenterologists have a crucial role in the management of these patients, however difficulties remain in the detection and management of complications of HHT in the gastrointestinal tract.

Intrapancereatic abscess due to arteriovenous malformation involving the entire pancreas: A case report and review of the literature

INTRODUCTION

The described case is a patient with pancreatic arteriovenous malformation involving the entire pancreas and complicated with intrapancereatic abscess.

PRESENTATION OF CASE

A 47 years-old was suffering from episodes of abdominal pain and vomiting with multiple hospital visits without reaching a diagnosis for four months. Contrast-enhanced computed tomography scan (CECT) done which shows a 1.6×1.4cm fluid collection was seen in uncinate process of the pancreas, Magnetic resonance imaging (MRI) demonstrates abnormal vasculature involving the pancreas. Therefore patient diagnosed as a case of pancreatic arteriovenous malformation (P-AVM), which confirmed by Selective Computed Tomography Angiogram (CT Angiogram).

DISCUSSION

Normal investigations in the first attempts can lead to miss pancreatic arteriovenous malformation (P-AVM), and can lead to serious and fatal.

CONCLUSION

Early diagnosis and treatment of (P-AVM) is very important even in asymptomatic patients. Conservative treatment in complicated and big P-AVM appears ineffective as surgical resection.