Circulation. 2001;103:e36-e38
(Circulation. 2001;103:e36.)
© 2001 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Rendu-Osler-Weber Disease
Transthoracic Doppler Ultrasonographic Findings
Hajime Kataoka, MD;
Osamu Matsuno, MD
From the Division of Internal Medicine, Nishida Hospital, Oita, Japan.
Correspondence to Hajime Kataoka, MD, Division of Internal Medicine, Nishida Hospital, 3-3-24 Ohte-machi, Saiki-City, Oita 876-0831, Japan.
A 75-year-old
man was admitted to the hospital because of transient unconsciousness
and dysarthria. Brain CT and MRI demonstrated a recent cerebellar
infarction. Physical examination revealed a continuous extracardiac
murmur maximally auscultated (Levine III) between the inner edge of the
right scapula and the upper thoracic vertebrae. Color Doppler thoracic
ultrasonography recorded at this point disclosed abnormal blood flow
signals, ie, red (tubular configuration;
Figure 1A
), mosaic (circular;
Figure 1B), and blue (tubular;
Figure 1C) signals. Pulsed-Doppler ultrasonographic
recordings obtained from the midportion of each signal demonstrated
flows toward the transducer
(Figure 2A), bidirectional
(Figure 2B), and away from the transducer
(Figure 2C) on the right upper part of the patient’s
back. 3D contrast-enhanced MR angiography
(Figure 3) confirmed anomalous vessels, indicated by the
color Doppler ultrasonographic findings; ie, a feeding artery (arrows)
originating from the right pulmonary artery, arteriovenous fistula
(asterisk), and draining vein (arrowheads) coursing into the left
atrium. Multiple
telangiectasias1 were
observed on the gastric endoscopy as cherry-red hillocks
(Figure 4).
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Figure 1. A through C, Color Doppler thoracic ultrasonograms in different planes showing most distinct signals obtained from each anomalous vessel.
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Figure 2. A through C, Corresponding pulsed-Doppler ultrasonograms for each signal presented in Figure 1A to 1C.
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Figure 3. 3D contrast-enhanced MR angiography. LA indicates left atrium; PA, pulmonary artery; arrows, feeding artery originating from right pulmonary artery; arrowheads, draining vein coursing into left atrium; and  , arteriovenous fistula.
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Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
References
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Guttmacher
AE, Marchuk DA, White RI. Hereditary hemorrhagic telangiectasia.
N Engl J Med. 1995;333:918–924. [Free Full Text]
