{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan"
      ],
      "name": "Atsushi Ikehata"
    },
    {
      "affiliations": [
        "Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan"
      ],
      "name": "Osamu Kido"
    }
  ],
  "title": "Complementary role of imaging in the diagnosis of hereditary haemorrhagic telangiectasia presenting with a bleeding duodenal ulcer",
  "uid": "c7425fe3-8893-5ffd-80d2-74200841b5c8"
}