Medical Image of the Week: Osler-Weber-Rendu Syndrome

A 44 year-old woman with Osler-Weber-Rendu syndrome (commonly known as Hereditary Hemorrhagic Telangiectasia [HHT]) presented with hemoptysis. Her past history was notable for hemoptysis treated with hemostatic coil placement in multiple areas of arteriovenous (AV) malformations.  Her last episode of hemoptysis was 15 years prior to this admission and she had not been seen by a physician for almost 2 years.  Her CT Chest revealed multiple previous hemostatic coils and new AV malformations.

Figure 1. Chest X-Ray: Multiple hemostatic metallic coils throughout both lungs.

Figure 2. Axial images of CT Chest: Metallic foreign bodies are seen within the lungs. Several areas are enhancing and somewhat serpentine, possibly representing small residual or new areas of arteriovenous abnormality with dilated veins (arrows).

Tauseef Afaq Siddiqi MD, Toral Parikh MD and Phillip Factor DO

Department of Medicine, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona, Tucson, AZ 85724, United States

Reference as: Siddiqi TA, Parikh T, Factor P. Medical image of the week: Osler-Weber-Rendu syndrome. Southwest J Pulm Crit Care. 2013;6(5):241-2. PDF

Medical Image of the Week: Hepatocellular Carcinoma with Pulmonary Metastasis

A 58-year-old man with a history of hepatitis-C, liver cirrhosis and hepatocellular carcinoma treated with sorafenib and chemoembolization was admitted with septic shock due to spontaneous bacterial peritonitis with concomitant hemorrhage and acute renal failure.  The patient did not respond to broad-spectrum antibiotics, aggressive care with multiple vasopressors and ventilatory support and died shortly after admission.  An autopsy was performed revealing hepatocellular carcinoma with extensive intra-abdominal and thoracic metastasis.

Figure 1. Axial CT image of upper abdomen revealing cirrhotic liver with a large mass in left hepatic lobe (star) and massive ascites.

Figure 2. Cross-section of liver showing green-yellow hepatocellular carcinoma in left hepatic lobe (star).

Figure 3. Cross-section of lung showing numerous green-yellow metastatic lesions in pulmonary parenchyma and hilar nodes.

Figure 4.  Hematoxylin and eosin (40x [Panel A] and 100x [Panel B]) stained lung demonstrating micro-tumor emboli (arrows) of hepatocellular carcinoma.

Tauseef Afaq Siddiqi MD¹, Sachin Chaudhary MD¹,Nicholas Hernandez MD², Christopher Geffre MD² and Richard Sobonya MD²

¹ Department of Medicine, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona, Tucson, AZ 85724, United States

² Department of Pathology, The University of Arizona, Tucson, AZ 85724, United States.

Reference as: Siddiqi TA, Chaudhary S, Hernandez N, Geffre C and Sobonya R. Medical image of the week: hepatocellular carcinoma with pulmonary metastasis. Southwest J Pulm Crit Care. 2013;6(5):234-6. PDF