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A man in his 40s was referred to our hospital with a 1-day history of melena. His medical history was remarkable for a duodenal ulcer in his 30s, recurrent epistaxis and iron deficiency anaemia. His father had died of hepatic failure due to hereditary haemorrhagic telangiectasia (HHT; also called Osler-Weber-Rendu syndrome). Contrast-enhanced CT revealed contrast enhancement in the duodenal wall ( figure 1, arrow) and asymmetric contrast enhancement in the liver (figure 1, dashed circle). Esophagogastroduodenoscopy revealed a small ulcer on the duodenum (figure 2a), and water flushing revealed spurting bleeding (figure 2b), which was stopped with three clips (figure 2c). 3 weeks later, the duodenal ulcer rebleeded (figure 2d), and soft coagulation was performed (figure 2e). There was no further bleeding, and the ulcer scarred 2 months later (figure 2f). Typical mucosal telangiectasias were scattered throughout the duodenum (figure 2f, arrowhead). Colour Doppler (figure 3a) and contrast-enhanced ultrasonography (figure 3b, 3c) revealed tortuous hepatic arteries (arrows), cauliflower-shaped shunts (arrowheads) and intrahepatic veins (asterisks). After performing the ultrasonography examination, we interpreted the shunt as an arteriovenous shunt. Based on the Curaçao diagnostic criteria,1 2 he was diagnosed with HHT.