PMC9793055_01
(a and b) Clubbed nails on all four limbs and (c) Pectus carinatum.
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Physical examination (Figure 1) showed clubbed nails on all four limbs, pectus carinatum with lordosis, right lower abdominal tenderness, and no rebound pain.
Endoscopy showed (a and b) telangiectasias in the duodenum and stomach and (c
and d) multiple juvenile polyps in the intestine.
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Gastroscopy showed telangiectasia of the duodenum and fundus of the stomach [Figure 2(a) and (b)], and multiple colon polyps with a long, stalk-like and lobulated appearance [Figure 2(c) and (d)].
CTA of both lungs showed (a and b) obvious thickening, an arteriovenous
anastomosis, forming a malformed vascular mass shadow, and "I-shaped"
embolism nail. Abdominal enhanced CT showed (c and d) intussusception with
significant thickening and enhancement of the local intestinal wall,
suggesting multiple polyps.
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Pulmonary artery computed tomography angiography (CTA) showed multiple pulmonary AVMs in both lungs (Figure 3(a) and (b)). Low-tension CT of the small intestine (Figure 3(c) and (d)) showed multiple polyps and right abdominal intussusception, and a right portal vein right hepatic vein fistula was considered.