Let’s talk about a syndrome that makes every intern sweat during ward rounds and every examiner smile during vivas: Osler-Weber-Rendu Syndrome, also known (less melodramatically) as Hereditary Hemorrhagic Telangiectasia (HHT).
It’s rare, it’s sneaky, and it’s got bleeding in all the wrong places. So how do we remember its key features? Simple — we TEACH it. Literally.
Mnemonic Table: “T.E.A.C.H”
| Letter | Feature | Explanation |
|---|---|---|
| T | Telangiectasia | Dilated, fragile vessels—usually on lips, tongue, nasal mucosa, fingertips. Basically, capillaries that forgot they have limits. 🩸 |
| E | Epistaxis | Often recurrent and spontaneous. That one patient who always shows up with a nosebleed and a tissue stuffed like a grenade pin. |
| A | Arteriovenous Malformations (AVMs) | Found in lungs, liver, brain, and spine. These are high-flow connections, not your usual Sunday stroll vasculature. 💥 |
| C | Cerebral abscess | Secondary to paradoxical emboli (due to pulmonary AVMs). When bacteria skip the lungs and go straight to the brain—because why not? 🧠 |
| H | Hemorrhages (Pulmonary, GIT) | GI bleeds in mid-age, pulmonary hemorrhage in AVM cases. Warning: one coffee-ground emesis, and it’s game on. ☕🩸 |
🧠 Clinical Pearl from Quetta
We had a case from Chaghi — a middle-aged school teacher who came in with chronic epistaxis and unexplained anemia. Dr. Basit Khan raised an eyebrow and said, “Another GI bleed? Or has your nose decided to moonlight as a faucet again?”
Sure enough, on examination: oral telangiectasias, and on CT chest, pulmonary AVMs lighting up like someone had used highlighters on the vasculature.
Later that week, he spiked a fever and became confused. MRI showed a frontal lobe abscess — textbook paradoxical septic embolism from unfiltered bugs passing through those rogue pulmonary shunts.
Dr. Imran Baloch, ever the optimist, said, “The heart might be four-chambered, but in this guy, it’s a one-way smuggling route to the brain.” 🤦♂️
Osler-Weber-Rendu might be rare, but when it shows up, it does so with full cinematic flair: bleeding, AVMs, abscesses, and confusion (yours and the patient’s).
So keep your eyes open, your hemoglobin charted, and your CT scanner warm.
Next time you see telangiectasias and a nosebleed, don’t reach for nasal packing alone — reach for TEACH!! 😀
Happy learning, folks! 🙂
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
Sheikh Khalifa Bin Zayed Hospital, Quetta
