case_images: PMC11259490_01
case_images: These are the images of Esophagogastroduodenoscopy (EGD) illustrating gastric erosions (image A) and GAVE with bleeding (image B). In response, a biopsy was performed and a hemoclip was placed (image C). GAVE was treated with argon plasma coagulation (image D). A follow-up EGD three days later showed that the erosions persisted (image E), but GAVE was no longer bleeding (image F).
case_images: jchim-14-03-093f1.jpg
case_images: PMC11259490_01_jchim-14-03-093f1.jpg
case_images: f1-jchim-14-03-093
case_images: An urgent EGD was pursued, which demonstrated gastritis and gastric erosions in the antrum (Fig. 1A). There was evidence of GAVE with bleeding in the distal body and antrum (Fig. 1B). The GAVE lesion was treated with APC (Fig. 1D). A follow-up EGD three days after presentation showed resolution of active bleeding associated with the GAVE lesions (Fig. 1E and F).
case_images: These are the images of ultrasound showing large-volume ascites noted throughout the abdomen (white arrows in A, B and C). Image D shows atrophied, cirrhotic liver (yellow arrowhead) measuring 9 cm in length with associated ascites (red arrowhead). Note splenomegaly (white arrowhead) in image E. Image F is a hepatic/portal venous doppler sonographic image demonstrating patent TIPS with normal blood flow (white arrows).
case_images: jchim-14-03-093f2.jpg
case_images: PMC11259490_01_jchim-14-03-093f2.jpg
case_images: f2-jchim-14-03-093
case_images: Subsequent ultrasound of the abdomen showcased a cirrhotic liver without focal lesions (red arrowhead, Fig. 2D) and splenomegaly (white arrowhead, Fig. 2E). A large volume ascites (white arrows, Fig. 2A, B, and 2C; yellow arrowhead, Fig. 2D) and a contracted gallbladder with gallstones but no sonographic evidence of acute inflammation was noted. Hepatic and portal venous ultrasound with doppler showed patent main portal and main right hepatic veins with normally directed flow and no evidence of portal or hepatic venous thrombosis, stenosis, or occlusion (white arrows, Fig. 2F).
case_images: These are hematoxylin and eosin-stained histologic sections of stomach biopsy and liver biopsy respectively. Image A shows gastric antral-type mucosa with ectactic vessels, fibrin thrombi, fibromuscular proliferation, and markedly reactive changes, consistent with gastric antral vascular ectasia. Image B shows significant bridging fibrosis, consistent with cirrhosis.
case_images: jchim-14-03-093f3.jpg
case_images: PMC11259490_01_jchim-14-03-093f3.jpg
case_images: f3-jchim-14-03-093
case_images: Biopsies were taken (results shown in Fig. 3A), and a hemoclip was placed to prevent biopsy-related bleeding (Fig. 1C). Explant biopsy showed inactive cirrhosis with NASH (Fig. 3B).