Recurrent epistaxis and painless episodes of hematuria in association with a history of two siblings with recurrent epistaxis but no laboratory evidence of hematuria led to the presumptive diagnosis of hereditary hemorrhagic telangiectasia (HHT) in the patient. A nasal endoscopic evaluation demonstrating multiple telangiectases in the anterior nasal septum and medial concha confirmed the diagnosis.
2.
Cystoscopy of the urinary bladder is the most helpful diagnostic method for this patient. Many tortuous and engorged vessels were seen by this evaluation in the bladder mucosa (Fig. 1).
Fig. 1
Photograph of bladder mucosa showing telangiectatic vessels
