Figure 3. Hepatic AV malformation on doppler ultrasound
He was frequently hospitalized because of the severe anemia and high output heart failure; received frequent blood transfusions and put on diuretics and had nasal packing applied during episodes of nasal bleeding. Due to ongoing gastrointestinal bleeding, he was transferred to another hospital for endoscopic intervention where electrocauterization (electro-ablation) of gastric and duodenal telangiectasias was done, after which there was no drop in hemoglobin and he did not require transfusion. He continued to have bouts of massive epistaxis for which silver nitrate cauterization was done, bleeding was arrested and septal dermoplasty was planned if any recurrence.