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Initial MRI findings on admission. (
A
) T1 sagittal MRI without contrast demonstrates hyperintense hemorrhagic focus in the midbrain (arrow). (
B
) T1 post gadolinium with peripherally enhancing hypointense focus in the distal spinal cord (arrow). (
C
) T1 post contrast arterial enhancing serpiginous structures in the hepatorenal space (arrows) and associated with the descending colon (arrow). MRI, magnetic resonance imaging.
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 Shortly after transfer, magnetic resonance imaging (MRI) of her brain/spine revealed an intracranial hemorrhage within the left midbrain/pons and left middle cerebellar peduncle ( Fig. 1A ). A probable intramedullary AVM within the conus medullaris without findings of hemorrhage was also identified ( Fig. 1B ). MRI of her abdomen showed multiple tortuous AVMs within the transverse and descending colon which appeared to communicate with the superior mesenteric artery and vein, as well as a large AVM in the hepatorenal space ( Fig. 1C ).
Gross resection of patient's ascending and transverse colon with multiple, large AVMs (arrows). AVMs, arteriovenous malformations.
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AVMs in the bowel mesentery which could allow for individual ligation and/or cauterization, and potentially avoid a bowel resection. As seen in Fig. 2 , the AVMs were found to be encasing the colonic wall, invading through the serosa, and into the lumen.
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Endoscopic images revealing multiple telangiectasias in ascending colon/rectum.
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AVMs in the ascending colon that were not visualized on the external surface of the bowel during her initial surgery ( Fig. 3 ).
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