Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

View all Images (4)

Hereditary hemorrhagic telangiectasia - Nail and Distal Digit
See also in: Overview,External and Internal Eye,Oral Mucosal Lesion
Other Resources UpToDate PubMed

Hereditary hemorrhagic telangiectasia - Nail and Distal Digit

See also in: Overview,External and Internal Eye,Oral Mucosal Lesion
Contributors: Erin X. Wei MD, Bertrand Richert MD, Robert Baran MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant hereditary disease (occasional cases are sporadic) causing mucocutaneous and visceral telangiectasias and arteriovenous malformations (AVMs). Several genetic forms exist: type 1 with a mutation in endoglin on chromosome 9 (ENG), type 2 with a mutation in an activin receptor-like kinase 1 gene on chromosome 12 (ACVRL1), type 3 with an as yet undefined defect, and juvenile polyposis / HHT with mutations in the gene SMAD4. The prevalence of pulmonary and cerebral AVMs is higher in type 1, while hepatic AVMs are more common in type 2. Juvenile polyposis / HHT is characterized by intestinal polyps and may also have AVMs. The most common type of HHT is type 1, followed by type 2; type 3 is rare.

HHT is a multisystem disease with most symptoms typically presenting in adulthood, in the second or third decade, and most experiencing the onset of symptoms by age 20. There is no apparent race or sex predilection. The overall prognosis is good, and most patients have a normal life expectancy.

Epistaxis is the most common and earliest sign of disease, presenting in childhood, with an average age of onset of 12 years. Telangiectasia presents later in life ranging from postpubescent years to adulthood. Telangiectasias can affect the skin, nervous system, and gastrointestinal (GI) and genitourinary tracts. Mucocutaneous lesions are seen most frequently on the face, lips, tongue, oral mucosa, and hands. Nasal and GI lesions are common. Bleeding may occur within the upper or lower GI tract and can lead to iron-deficiency anemia. Pulmonary AVMs can cause hypoxemia, pulmonary hemorrhage, shunts, and paradoxical embolic disease (eg, stroke) due to disruption in blood flow. Portal hypertension, biliary tract disease, and high-output heart failure may occur from intrahepatic shunts. Hemorrhage within the brain or spinal cord can cause significant neurologic defects and death. Paraplegia can result from spinal AVMs. The spleen and urinary tract can also be involved.

In the nail unit, subungual hemorrhages and telangiectasias may be evident.

Codes

ICD10CM:
I78.0 – Hereditary hemorrhagic telangiectasia

SNOMEDCT:
21877004 – Hereditary hemorrhagic telangiectasia

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed:01/19/2021
Last Updated:01/17/2022
Copyright © 2024 VisualDx®. All rights reserved.
Hereditary hemorrhagic telangiectasia - Nail and Distal Digit
See also in: Overview,External and Internal Eye,Oral Mucosal Lesion
A medical illustration showing key findings of Hereditary hemorrhagic telangiectasia : Buccal mucosa, Exertional dyspnea, Hematuria, Lips, Tongue, Conjunctival injection, Epistaxis, Hematemesis, Hemoccult positive stool, Hemoptysis, Blanching macules, Telangiectasias
Clinical image of Hereditary hemorrhagic telangiectasia - imageId=46847. Click to open in gallery.  caption: 'Bright red macules and papules on the lips.'
Bright red macules and papules on the lips.
Copyright © 2024 VisualDx®. All rights reserved.