Symptoms to Diagnosis

Abdominal pain in a patient with epistaxis, telangiectasias, and arteriovenous malformations

Akash Mathavan, MD, Akshay Mathavan, MD, Andreas Giovanni Zori, MD, Marc Stuart Zumberg, MD, Jeb M. Justice, MD and Ali Ataya, MD
Cleveland Clinic Journal of Medicine October 2024, 91 (10) 601-608; DOI: https://doi.org/10.3949/ccjm.91a.24042

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Computed tomography 3-phase imaging of the abdomen and pelvis showed (A) extensive arteriovenous malformations in the liver (red arrows), predominantly involving shunts from the right and left hepatic arterial branches to the hepatic portal vein. (B) Repeat computed tomography imaging of the abdomen and pelvis after 3 months of treatment with bevacizumab revealed an unchanged appearance of the liver, with extensive arteriovenous malformations (red arrows).

Tables

  • TABLE 1

    The patient’s laboratory test results during initial presentation at the emergency department

    Test (reference range)Results
    Hemoglobin (12–16 g/dL)9.0
    Mean corpuscular volume (78–100 fL)72
    Red cell distribution width (11.0%–14.0%)23.7
    Platelet count (150–450 × 109/L)348
    Ferritin (11–307 ng/mL)6.8
    Iron (35–150 μg/dL)20
    Total iron binding capacity (225–430 μg/dL)370
    Transferrin saturation (20%–55%)5
    Aspartate aminotransferase (0–37 U/L)15
    Alanine aminotransferase (0–35 U/L)8
    Alkaline phosphatase (33–133 U/L)126
    Total bilirubin (0–1 mg/dL)0.9
    Direct bilirubin (0–0.2 mg/dL)0.2
    Thyroid-stimulating hormone (0.4–5.0 mIU/L)2.6
  • TABLE 2

    The patient’s laboratory test results at time of treatment and follow-up

    Test (reference range)Results at time of therapyaResults at follow-upb
    Hemoglobin (12–16 g/dL)7.110.8
    Mean corpuscular volume (78–100 fL)7277
    Red cell distribution width (11.0%–14.0%)22.616.9
    Platelet count (150–450 × 109/L)386293
    Ferritin (11–307 ng/mL)4.011.2
    Iron (35–150 μg/dL)1928
    Total iron binding capacity (225–430 μg/dL)366340
    Transferrin saturation (20%–55%)58
    Aspartate aminotransferase (0–37 U/L)2035
    Alanine aminotransferase (0–35 U/L)1124
    Alkaline phosphatase (33–133 U/L)149166
    Total bilirubin (0–1 mg/dL)0.90.6
    Direct bilirubin (0–0.2 mg/dL)0.10.2
    Thyroid-stimulating hormone (0.4–5.0 mIU/L)3.0152.8

    • ↵a Select laboratory parameters collected on day bevacizumab therapy was started.

    • ↵b Select laboratory parameters collected 3 months after bevacizumab therapy was started.

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