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Assembly

A Tangled Case of Incidental Hypoxemia

Author
Lena Xiao MD 1,2, Felix Ratjen MD PhD 1,2, Reshma Amin MD MSc 1,2
1Hospital for Sick Children, Toronto, ON, Canada
2University of Toronto, Toronto, ON, Canada



Case

A seven-year-old previously healthy girl presented for an elective endoscopy to investigate for dysphagia and was incidentally found to have low baseline oxygen saturations of 91-94%. There was a longstanding history of exercise intolerance as well as 1-2 episodes of epistaxis monthly. There was no history of hemoptysis or recurrent respiratory infections. On examination, she was found to have facial telangiectasias and digital clubbing. Her bloodwork revealed polycythemia with hemoglobin 156 g/L (15.6 g/dL) and hematocrit 47.2%. Echocardiography was unremarkable. Chest x-ray revealed subtle ground-glass nodular opacities suspicious for an infectious process. Testing for mycoplasma, respiratory viruses, and COVID-19 were negative.

A contrast-enhanced CT with maximum-intensity projection reconstruction showed the following:

contrast-enhanced CT with maximum-intensity projection reconstruction
contrast-enhanced CT with maximum-intensity projection reconstruction

Question

What is the most likely cause of her hypoxemia?

A. Hepatopulmonary syndrome
B. Hereditary hemorrhagic telangiectasia
C. Tuberculosis
D. Fanconi anemia

Answer