Profound Iron Deficiency Anemia in a Patient with Diffuse Cavernous Hemangioma

Abstract

Purpose: A 39-year-old male presented with dyspnea and recurrent hematochezia. Colonoscopy 10 years prior showed vascular lesions and hemorrhoids. He had no follow up since then. Physical exam revealed axillary lymphadenopathy. Laboratory evaluation revealed severe iron deficiency anemia (Hct 16, MCV 52, Iron 12). CT revealed a right hilar mass compressing the right mainstem bronchus and multiple lung nodules. Rectum was diffusely thickened extending into the sigmoid colon, associated with numerous phleboliths. (Figure 1) Several hepatic lesions were seen. Colonoscopy showed increased mucosal vascular pattern from the rectum to distal sigmoid (Figure 2) and a patchy area in transverse colon. Endoscopic ultrasound demonstrated edematous vascular structures in this distribution. A heterogeneous, hypoechoic, circumferential lesion measuring 18 mm in maximal thickness involving all layers was noted. Doppler ultrasound showed vascular flow in the lesion (Figure 3). Calcified phleboliths were seen in the rectal wall. The patient was diagnosed with cavernous hemangiomatosis of the colon and pulmonary non-small cell carcinoma. Colonic cavernous hemangiomatosis is rare and benign, with infrequent simultaneous liver involvement. There is frequent delay in diagnosis. Surgical resection is the preferred treatment modality for diffuse disease.Figure 1: No Caption available.Figure: [1178] Figure 2Figure: [1178] Figure 3