SIR 2003 Film Panel Case 3: Hemorrhagic Hereditary Telangectasia with Median Arcuate Ligament Compression

A 49-year-old female presented with 2 days of hematemesis. Her medical history is significant for multiple gastrointestinal bleeds, hypertension, and ETOH abuse. At admission, her vital signs were blood pressure of 180/90, pulse of 80, and hematocrit of 27.8. Esaphagogastroduodenoscopy revealed a 1-cm ulcer with visible vessel in the high lesser curvature of the stomach and two smaller ulcerations in the antrum. The patient was administered 2 units of packed red blood cells and was treated with Ranitidine, Carafate, and antacids. Arteriography was performed to further evaluate the etiology of the bleeding and in particular to identify any underlying vascular mass within the stomach (e.g. leiomyoma) which may have ulcerated (Fig 3.1). Selective celiac arteriography (early and delayed phase), AP and lateral abdominal aortography, and AP pelvic arteriography were performed.