Monday, February 2, 2009

Bleeder

A 20 year old man without a significant medical history presents to the emergency room with hematemesis. The emergency department stabilizes him hemodynamically and GI is consulted to scope him. He reports no alcohol abuse, no smoking, no NSAID use. In the endoscopy, this lesion is seen:

The gastroenterologist says, "Aha! This is not peptic ulcer disease, esophageal varices, or an arteriovenous malformation."

Challenge: Well, in that case, what is it?

Image shown under fair use.

2 comments:

deardoc said...

Gastroesophageal disease. I think the picture shows Barretts' esophagus..metaplastic change in esophageal epithelium.

Craig Chen said...

Bleeder

This is a Dieulafoy’s lesion, a dilated aberrant submucosal vessel which erodes the overlying epithelium in the absence of a primary ulcer. The submucosal artery is 1-3mm (mucosal capillaries 0.1-0.3mm), usually located in the upper stomach but can be found anywhere in the GI tract. Etiology is unknown, but they are considered congenital.

Source: UpToDate.