Angiodysplasia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nikita Singh, M.D.[2]

Overview

Angiodysplasia must be differentiated from other diseases that cause hematochezia, melena, and iron deficiency anemia, such as hemorrhoids, diverticular disease, and colon cancer.

Differentiating Angiodysplasia from other Diseases

Angiodysplasia must be differentiated from from other diseases that cause hematochezia, melena, and iron deficiency anemia such as:

• Diverticulitis
• Hemorrhoids
• Colon cancer
• Massive upper GI bleed
• Inflammatory bowel disease

Diseases	Clinical manifestations						Para-clinical findings							Gold standard
	Symptoms			Physical examination
							Lab Findings			Imaging			Histopathology
	Abdominal pain	Lower GI Bleed	Systemic symptoms (fever, weight loss, sweats)	Physical exam 1	Physical exam 2	Physical exam 3	Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3
Diverticulitis	+	+	-	Left lower quadrant abdominal tenderness	Bowel sounds hypoactive/normoactive	Fever	Leukocytosis	Elevated ESR and CRP		Radiological test of choice - CT of abdomen and pelvis with contrast	Abdominal Ultrasound	MRI abdomen		Colonoscopy after resolution of inflammation
Hemorrhoids	- (anal pain)	+	-	Skin tags	Fistulas or fissures	Prolapsed hemorrhoid							External hemorrhoids - distal to dentate line. Internal hemorrhoids - proximal to dentate line.	Anoscopy
Colon cancer	+/-	+/-	+	Lmyphadenopathies	Abdominal mass	Hepatomegaly (metastasis)	Tumor marker - CEA			CT with contrast chest, abdomen and pelvis			Majority of colorectal cancers are carcinomas.	Colonoscopy
Massive upper GI bleed	+	+	-	Hemodynamic instability	Upper abdominal tenderness	Pale skin	Acute bleeding - normocytic anemia	Elevated BUN-to-Creatinine ratio >30:1		CT angiography				Endoscopy
Inflammatory bowel disease	+	+/-	+	Tachycardia, fever,	Occult blood on digital rectal exam	Anal fistulas, abscesses	Microcytic anemia	Leukocytosis	Elevated ESR, CRP	Abdominal X ray - free air, bowel obstruction, toxic megacolon	Barium studies	Ultrasound/CT/MRI	UC- crypt abscess Crohn's- transmural involvement, granulomas	Endoscopy
Angiodysplasia	-	Occult	-	Signs of anemia	Systolic ejection murmur (if aortic stenosis)	Rarely, orthostasis or hypotension	Microcytic anemia	Renal and liver function tests	Coagulation studies	Radionuclide scanning	CTA/MRA	Upper GI endoscopy and colonoscopy	Tortuous, dilated veins, venules and capillaries in the colonic mucosa and submucosa	Endoscopy