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AJR Teaching File: High-Output Cardiac Failure in a Patient with a History of Hereditary Hemorrhagic Telangiectasia

Trevor Clayton1, Kevin P. Banks1 and Liem T. Bui-Mansfield1,2,3

1 San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Department of Radiology, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234-6200.
2 Department of Radiology, Wake Forest University, Winston-Salem, NC 27157-1088.
3 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.


Figure 1
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  		Fig. 1A —62-year-old woman with history of hereditary hemorrhagic telangiectasia who presents with high-output cardiac failure. Anteroposterior chest radiograph reveals cardiomegaly and enlargement of central pulmonary vasculature, cephalization of pulmonary blood flow, and left pleural effusion.

 

Figure 2
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  		Fig. 1B —62-year-old woman with history of hereditary hemorrhagic telangiectasia who presents with high-output cardiac failure. Single axial contrast-enhanced CT image of chest obtained 2 years previously shows opacity in right upper lobe that measures 10 x 9 x 15 mm. Pulmonary vessels are seen entering and exiting opacity, suggestive of pulmonary arteriovenous malformation.

 

Figure 3
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  		Fig. 1C —62-year-old woman with history of hereditary hemorrhagic telangiectasia who presents with high-output cardiac failure. Axial images from early (C) and late (D) arterial phases of contrast-enhanced abdominal CT show hepatomegaly, enlarged inferior vena cava, and early opacification of hepatic veins. Numerous subcentimeter nodules fill liver and show rapid enhancement, consistent with telangiectasia. No findings of cirrhosis or portal hypertension are evident.

 

Figure 4
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  		Fig. 1D —62-year-old woman with history of hereditary hemorrhagic telangiectasia who presents with high-output cardiac failure. Axial images from early (C) and late (D) arterial phases of contrast-enhanced abdominal CT show hepatomegaly, enlarged inferior vena cava, and early opacification of hepatic veins. Numerous subcentimeter nodules fill liver and show rapid enhancement, consistent with telangiectasia. No findings of cirrhosis or portal hypertension are evident.

 

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