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Yasrab M, Crawford CK, Fishman EK, Kawamoto S. CT imaging of pulmonary artery aneurysms in the emergency department - What you need to know. Curr Probl Diagn Radiol 2025:S0363-0188(25)00094-5. [PMID: 40413118 DOI: 10.1067/j.cpradiol.2025.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 05/12/2025] [Accepted: 05/16/2025] [Indexed: 05/27/2025]
Abstract
Pulmonary artery (PA) aneurysms are rare vascular abnormalities with potentially life-threatening complications such as rupture, massive hemoptysis, and pulmonary infarction. These conditions are often asymptomatic and incidentally detected but can present with nonspecific symptoms like cough, dyspnea, or hemoptysis in an emergency setting. Multidetector CT pulmonary angiography (CTPA) has outshone traditional angiography, supplemented by advanced 3D post-processing techniques such as maximum intensity projection (MIP), volumetric rendering (VR), and cinematic rendering (CR) techniques, playing a pivotal role in diagnosis and management of PA aneurysms. This pictorial essay reviews eight cases of PA aneurysms and pseudoaneurysms, exploring their diverse etiologies, imaging findings, and the application of 3D imaging to enhance diagnostic confidence and procedural planning. Through these cases, we highlight the critical role of advanced imaging and post-processing reconstructions in the timely identification and treatment of these rare but high-risk vascular entities in the emergency setting.
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Affiliation(s)
- Mohammad Yasrab
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Charles K Crawford
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Satomi Kawamoto
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Maruo K, Tanaka M, Inada Y, Fukui A, Tomatsuri N, Sato H, Inamori O, Yamashita M, Oka K, Okuyama Y. A Rare Case of Hughes-Stovin Syndrome Presenting with Ischemic Colitis Caused by an Arteriovenous Malformation. Intern Med 2025:5185-24. [PMID: 40222941 DOI: 10.2169/internalmedicine.5185-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2025] Open
Abstract
Hughes-Stovin syndrome (HSS) is an exceedingly rare disease characterized by thrombotic phlebitis and pulmonary or bronchial artery aneurysms. A 68-year-old man presented with ischemic colitis, and angiography revealed occlusion of the inferior mesenteric vein and arteriovenous malformation in the inferior mesenteric artery region. Medical treatment was unsuccessful, and a left hemicolectomy was therefore performed following coil embolization. Subsequently, a pulmonary artery aneurysm was incidentally detected, and coil embolization was performed. However, the patient developed deep vein thrombosis and a pulmonary embolism, which led to a diagnosis of HSS. To our knowledge, this is the first report of ischemic colitis as a presenting feature of HSS.
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Affiliation(s)
- Kazuya Maruo
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Makoto Tanaka
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Yutaka Inada
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Akifumi Fukui
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Naoya Tomatsuri
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Hideki Sato
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Osamu Inamori
- Department of Pathology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Masanori Yamashita
- Department of Radiology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Katsuhiko Oka
- Department of Cardiovascular Surgery, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Japan
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3
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de Lange C, Rodriguez CM, Martinez-Rios C, Lam CZ. Urgent and emergent pediatric cardiovascular imaging. Pediatr Radiol 2025; 55:604-621. [PMID: 38967787 PMCID: PMC11982110 DOI: 10.1007/s00247-024-05980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
The need for urgent or emergent cardiovascular imaging in children is rare when compared to adults. Patients may present from the neonatal period up to adolescence, and may require imaging for both traumatic and non-traumatic causes. In children, coronary pathology is rarely the cause of an emergency unlike in adults where it is the main cause. Radiology, including chest radiography and computed tomography in conjunction with echocardiography, often plays the most important role in the acute management of these patients. Magnetic resonance imaging can occasionally be useful and may be suitable in more subacute cases. Radiologists' knowledge of how to manage and interpret these acute conditions including knowing which imaging technique to use is fundamental to appropriate care. In this review, we will concentrate on the most common cardiovascular emergencies in the thoracic region, including thoracic traumatic and non-traumatic emergencies and pulmonary vascular emergencies, as well as acute clinical disorders as a consequence of primary and postoperative congenital heart disease. This review will cover situations where cardiovascular imaging may be acutely needed, and not strictly emergencies only. Imaging recommendations will be discussed according to the different clinical presentations and underlying pathology.
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Affiliation(s)
- Charlotte de Lange
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Behandlingsvägen 7, 416 50, Gothenburg, Sweden.
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Claudia Martinez-Rios
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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4
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Cook V, Wong K, Yan TD. Hughes Stovin syndrome is not associated with pulmonary embolism - Authors' reply. Lancet 2025; 405:380. [PMID: 39892906 DOI: 10.1016/s0140-6736(25)00154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 01/22/2025] [Indexed: 02/04/2025]
Affiliation(s)
- Victoria Cook
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirby Wong
- Department of Radiology, Hospital, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tristan D Yan
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia.
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5
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Ruffer N, Krusche M. Hughes Stovin syndrome is not associated with pulmonary embolism. Lancet 2025; 405:379-380. [PMID: 39892904 DOI: 10.1016/s0140-6736(24)02558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/20/2024] [Indexed: 02/04/2025]
Affiliation(s)
- Nikolas Ruffer
- Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Martin Krusche
- Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Deshpande PN, Venkatnarayan K, Krishnaswamy UM, Veluthat C, Niranjanmurthy L, Devaraj U, Ramachandran P. A rare cause of recurrent massive hemoptysis. Respirol Case Rep 2024; 12:e70091. [PMID: 39669668 PMCID: PMC11637534 DOI: 10.1002/rcr2.70091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 12/03/2024] [Indexed: 12/14/2024] Open
Abstract
Pulmonary artery aneurysmal rupture is a rare cause of massive hemoptysis. When the suspected origin of bleeding is the pulmonary artery, comprehensive evaluation is necessary to determine aetiology and guide appropriate management. Behçet's disease and Hughes-Stovin Syndrome (HSS) are important differentials to consider after infections and malignancy have been ruled out. Pulmonary artery aneurysms with aneurysmal wall enhancement and 'in-situ' thrombus should prompt the suspicion of HSS. Early diagnosis and treatment with immunosuppressants and endovascular interventions in selected patients may improve the prognosis and prevent episodes of fatal hemoptysis.
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Affiliation(s)
- Priya N. Deshpande
- Department of Pulmonary MedicineSt. John's National Academy of Health SciencesBengaluruIndia
| | - Kavitha Venkatnarayan
- Department of Pulmonary MedicineSt. John's National Academy of Health SciencesBengaluruIndia
| | | | - Chitra Veluthat
- Department of Pulmonary MedicineSt. John's National Academy of Health SciencesBengaluruIndia
| | - Likith Niranjanmurthy
- Department of RadiodiagnosisSt. John's National Academy of Health SciencesBengaluruIndia
| | - Uma Devaraj
- Department of Pulmonary MedicineSt. John's National Academy of Health SciencesBengaluruIndia
| | - Priya Ramachandran
- Department of Pulmonary MedicineSt. John's National Academy of Health SciencesBengaluruIndia
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7
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Chadli S, Maamar M, Khibri H, Tazi Mezalek Z, Harmouche H. Beyond the ordinary: TNF-alpha inhibitor as a rescue therapy in relapsing Hughes-Stovin syndrome with intracardiac thrombosis-a case report and literature review. Eur Heart J Case Rep 2024; 8:ytae398. [PMID: 39184169 PMCID: PMC11342963 DOI: 10.1093/ehjcr/ytae398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/10/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
Background Hughes-Stovin syndrome (HSS) is a rare vasculitis characterized by the association of thrombophlebitis with pulmonary artery aneurysms (PAAs). Because it is rarely reported, there are currently no established diagnostic criteria or standardized treatment guidelines for HSS. While conventional immunosuppressants are generally effective as first-line treatment, relapsing and refractory cases urge the need to investigate alternative therapies, such as TNF-alpha inhibitors. However, with only five cases published in the literature, knowledge of their efficacy in HSS is very limited. Case summary A 28-year-old man, with no past medical history, presented with haemoptysis, chest pain, and dyspnoea on exertion. Physical examination found bilateral leg swelling, with no associated lesions. CT angiography showed multiple bilateral PAA, proximal pulmonary artery thrombosis (PAT), and deep venous thrombosis (DVT) in the superior mesenteric vein and spleno-mesaraic confluence. Echocardiography was performed, identifying right intracardiac thrombosis (ICT). Initial management included high-dose corticosteroids and monthly cyclophosphamide cycles, followed by maintenance treatment with oral azathioprine. Eighteen months later, the patient presented with haemoptysis revealing a relapse of ICT and two new PAA. Infliximab was initiated, allowing complete and sustained remission after one year of follow-up. Discussion We report the challenging case of an HSS patient presenting with multiple PAA, proximal PAT, right ICT, and extended abdominal DVT. The positive response of our patient to infliximab, following a relapse under conventional immunosuppressants, supports the efficacy of TNF-alpha inhibitors as second-line treatment in relapsing/refractory HSS.
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Affiliation(s)
- Sarra Chadli
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Mouna Maamar
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Hajar Khibri
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Zoubida Tazi Mezalek
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
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Gozzi L, Cozzi D, Zantonelli G, Giannessi C, Giovannelli S, Smorchkova O, Grazzini G, Bertelli E, Bindi A, Moroni C, Cavigli E, Miele V. Lung Involvement in Pulmonary Vasculitis: A Radiological Review. Diagnostics (Basel) 2024; 14:1416. [PMID: 39001306 PMCID: PMC11240918 DOI: 10.3390/diagnostics14131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
Pulmonary vasculitis identifies a heterogeneous group of diseases characterized by inflammation, damage and necrosis of the wall of pulmonary vessels. The most common approach to classify vasculitis is according to etiology, therefore dividing them into primary and secondary, with a further sub-classification of primary vasculitis based on the size of the affected vessels (large, medium, and small). Pulmonary involvement is frequently observed in patients with systemic vasculitis and radiological presentation is not pathognomonic, but may vary between diseases. The main findings using high-resolution computed tomography (HRCT) include small vessel wall thickening, nodular lesions, cavitary lesions, reticular opacities, ground-glass opacities (GGO), consolidations, interlobular septal thickening, tracheobronchial stenosis, and aneurysmal dilatation of pulmonary arteries, with or without pleural effusion. Radiological diagnosis alone is difficult since signs and symptoms of lung vessel involvement are often non-specific and might overlap with other conditions such as infections, connective tissue diseases and neoplasms. Therefore, the aim of this review is to describe the most common radiological features of lung involvement in pulmonary vasculitis so that, alongside detailed clinical history and laboratory tests, a prompt diagnosis can be performed.
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Affiliation(s)
- Luca Gozzi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Zantonelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Caterina Giannessi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Simona Giovannelli
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Olga Smorchkova
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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9
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Emad Y, Ragab Y, Farber HW, Erkan D, Ibrahim O, Kindermann M, Tekavec-Trkanjec J, Jayakrishnan B, El-Shaarawy N, Kechida M, Young P, Pankl S, Fabi M, Bawaskar P, Kably I, Ghirardo S, Frikha F, Abou-Zeid A, Hassan M, Robinson C, Abdelbary MH, Tornes L, Margolesky J, Barman B, Bennji S, Agarwala MK, Alhusseiny K, Amezyane T, Silva RS, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Guffroy A, Kim JT, Ruffer N, Tharwat S, Cozzi D, Abdelali M, Joy TC, Sayed M, Sherwina J, Gheita T, Rasker JJ. Pulmonary embolism versus pulmonary vasculitis in Hughes-Stovin syndrome: Characteristic computed tomography pulmonary angiographic findings and diagnostic and therapeutic implications. HSS International Study Group. Thromb Res 2024; 239:109040. [PMID: 38795561 DOI: 10.1016/j.thromres.2024.109040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIM Hughes-Stovin syndrome (HSS) is a rare systemic vasculitis with widespread venous/arterial thrombosis and pulmonary vasculitis. Distinguishing between pulmonary embolism (PE) and in-situ thrombosis in the early stages of HSS is challenging. The aim of the study is to compare clinical, laboratory, and computed tomography pulmonary angiography (CTPA) characteristics in patients diagnosed with PE versus those with HSS. METHODS This retrospective study included 40 HSS patients with complete CTPA studies available, previously published by the HSS study group, and 50 patients diagnosed with PE from a single center. Demographics, clinical and laboratory findings, vascular thrombotic events, were compared between both groups. The CTPA findings were reviewed, with emphasis on the distribution, adherence to the mural wall, pulmonary infarction, ground glass opacification, and intra-alveolar hemorrhage. Pulmonary artery aneurysms (PAAs) in HSS were assessed and classified. RESULTS The mean age of HSS patients was 35 ± 12.3 years, in PE 58.4 ± 17 (p < 0.0001). Among PE 39(78 %) had co-morbidities, among HSS none. In contrast to PE, in HSS both major venous and arterial thrombotic events are seen.. Various patterns of PAAs were observed in the HSS group, which were entirely absent in PE. Parenchymal hemorrhage was also more frequent in HSS compared to PE (P < 0.001). CONCLUSION Major vascular thrombosis with arterial aneurysms formation are characteristic of HSS. PE typically appear loosely-adherent and mobile whereas "in-situ thrombosis" seen in HSS is tightly-adherent to the mural wall. Mural wall enhancement and PAAs are distinctive pulmonary findings in HSS. The latter findings have significant therapeutic ramifications.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Harrison W Farber
- Tufts University School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, MA, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Ashton Rd, Lancaster LA1 4RP, United Kingdom
| | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000 Zagreb, Croatia
| | | | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, 41522 Ismailia, Egypt
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, Monastir 5019, Tunisia
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair road, Mumbai 400008, Maharashtra, India
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127 Trieste, TS, Italy
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029 Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public health Department, Faculty of medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al kartoom square, al Azareta, Alexandria 21526, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of medicine, Helwan University, Egypt
| | - Leticia Tornes
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Jason Margolesky
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad 500096, India
| | - Khalid Alhusseiny
- Radiology department, Dr Erfan General hospital, Jeddah, Saudi Arabia
| | - Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, School of Medicine, Rabat, Morocco
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, 20231-092 Rio de Janeiro, RJ, Brazil
| | - Khalfan Al-Zeedy
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, Madrid 28222, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Izmir KatipÇelebi University Faculty of Medicine, Karabağlar, Izmir, Turkey
| | - Aurelien Guffroy
- Service d'immunologieclinique et médecine interne, centre de référence des maladies auto-immunes systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091 Strasbourg, France; UFR médecine Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Nikolas Ruffer
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Mabrouk Abdelali
- Department of Radiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Tubig C Joy
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Mona Sayed
- Nursing Medical Surgical Critical Care Department, Minia University, Minia, Egypt
| | - Juljani Sherwina
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Tamer Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands
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10
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Ruffer N, Krusche M, Holl-Ulrich K, Lötscher F, Kötter I. [Hughes-Stovin syndrome: a life-threatening manifestation of Behçet's syndrome]. Z Rheumatol 2024; 83:327-333. [PMID: 37280333 PMCID: PMC11058631 DOI: 10.1007/s00393-023-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Hughes-Stovin syndrome (HSS) is a systemic inflammatory condition of unknown origin that is considered to be part of the Behçet's syndrome (BS) spectrum. Recurrent venous thrombosis and superficial thrombophlebitis in combination with bilateral pulmonary artery aneurysms (PAA) represent the hallmark of HSS. The diagnostic evaluation includes computed tomography pulmonary angiography to detect signs of pulmonary vasculitis. The management of HSS is based on the European Alliance of Associations for Rheumatology (EULAR) recommendations for BS and mainly comprises immunosuppressive therapy with glucocorticoids and cyclophosphamide. In addition to drug therapy, PAA should be evaluated for interventional treatment. Spontaneous PAA rupture due to fragile vessel architecture can occur even in cases of remission and/or PAA regression.
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Affiliation(s)
- Nikolas Ruffer
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Konstanze Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Labor Lademannbogen MVZ GmbH, Hamburg, Deutschland
| | - Fabian Lötscher
- Universitätsklinik für Rheumatologie und Immunologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Ina Kötter
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
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11
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Khursheed T, Masood A, Khan MS, Sharif M, Shah S, Miraj MA. Hughes-Stovin Syndrome: A Case Report on a Rare, Life-Threatening Vasculitis. Mediterr J Rheumatol 2023; 34:565-569. [PMID: 38282949 PMCID: PMC10815522 DOI: 10.31138/mjr.290823.hsr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 01/30/2024] Open
Abstract
Hughes-Stovin Syndrome (HSS) is a rare vasculitic disorder characterised by widespread pulmonary artery aneurysms. It shares some features with Behçet disease. Currently, the diagnosis is based on clinical suspicion. Our case describes a young male who presented with haemoptysis and previous history of pulmonary embolism. Workup was essentially unremarkable, but imaging revealed multiple pulmonary artery aneurysms. Timely initiation of glucocorticoids and immunosuppression with cyclophosphamide led to improvement. High-dose glucocorticoids and immunosuppressants are the mainstays of treatment. Untreated cases can result in fatal outcomes.
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Affiliation(s)
- Tayyeba Khursheed
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Ahmed Masood
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Muhammad Sufyan Khan
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Muhammad Sharif
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Somaya Shah
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Muhammad Arqam Miraj
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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Emad Y, Ragab Y, Cozzi D, Ibrahim O, Abdelrahman W, Abdelali M, Kechida M, Hassanin M, Tharwat S, Salah S, Elshaarawy N, Frikha F, Hassanein S, Young P, Pankl S, Barman B, Abou-Zeid A, Rasker J. Pulmonary vasculitis in Behçet's disease: reference atlas computed tomography pulmonary angiography (CTPA) findings and risk assessment-management proposal. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023026. [PMID: 37712377 PMCID: PMC10540716 DOI: 10.36141/svdld.v40i3.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIM Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behçet's disease (BD).The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. METHODS The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. RESULTS Deep venous thrombosis was observed in 31(73.8%) patients, arterial thrombosis in 13(31%), peripheral arterial aneurysms in 12(286%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8(19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13(31), true unstable PAAs in 11(26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7(16.7%), unstable PAPs in 17(40.5%), the latter were associated with perianeurysmal leaking in 26(61.9%) and bronchial indentation in 19(45.2%).In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). CONCLUSION Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictor of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt identification and aggressive treatment. PAPs are a more serious aneurysmal pattern than true PAAs because they are a contained rupture of a PA branch in the context of pulmonary vasculitis.
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Affiliation(s)
- Yasser Emad
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt..
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy..
| | - Ossama Ibrahim
- 4 Morecambe Bay University Hospitals Lancaster, Ashton Rd.,Lancashire Lancaster LA1 4RP, UK.
| | - Walaa Abdelrahman
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mabrouk Abdelali
- Radiology Department, FattoumaBourguiba University Hospital, University of Monastir, Ruedu 1er juin 1955, 5019 Monastir, Tunisia.
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, FattoumaBourguiba University Hospital, University of Monastir, Ruedu 1er juin 1955, 5019 Monastir, Tunisia.
| | - Manal Hassanin
- 7Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Facultyof Medicine, Mansoura University, Mansoura, Dakahlia,Egypt.
| | - Shaimaa Salah
- 7Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
| | - Nashwa Elshaarawy
- 9Rheumatology and Rehabilitation Department, Facultyof Medicine, Suez Canal University, Ismailia 4.5 Km theRing Road, Ismailia 41522, Egypt.
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029, Sfax, Tunisia..
| | - Sara Hassanein
- 11Radiology Department, Assiut University Hospitals, Assiut, Egypt.
| | - Pablo Young
- Servicio de Clinica Medica, Hospital Britanico de BuenosAires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Sonia Pankl
- Servicio de Clinica Medica, Hospital Britanico de BuenosAires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Bhupen Barman
- Department of General Medicine, North Eastern IndiraGandhi Regional Institute of Health and Medical Sciences(NEIGRIHMS), Mawdiangdiang, Shillong 793018,Meghalaya, India.
| | - Alaa Abou-Zeid
- Public Health Department, Faculty of Medicine, Cairo University, Kasr Al‑Ainy St., Cairo 11562, Egypt.
| | - Johannes Rasker
- 15Faculty of Behavioral, Management and Social Sciences,Department Psychology, Health and Technology,University of Twente, Drienerloolaan 5, 7522NB Enschede,The Netherlands.
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Joy TC, Sherwina J, Fernando A, Limpin ME, Mateo MP, Alhusseiny K. Pulmonary artery pseudoaneurysms (PAPs) in Hughes-Stovin syndrome (HSS) as an emerging concept for a potentially fatal course. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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14
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Villacis-Nunez DS, West Z, Khan AY, Rodriguez F, Shane AL, Rytting H, Shashidharan S, Clifton MS, Woods G, Clabby M, Prahalad S. Successful Medical-Surgical Management of Intracardiac Thrombosis and Pulmonary Pseudoaneurysms in an Adolescent With Hughes-Stovin Syndrome. J Investig Med High Impact Case Rep 2023; 11:23247096231166672. [PMID: 37032536 PMCID: PMC10101212 DOI: 10.1177/23247096231166672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
We present an adolescent male with a single intracardiac mass and pulmonary emboli, complicated by peripheral venous thrombosis and subsequent development of pulmonary pseudoaneurysms, leading to diagnosis of Hughes-Stovin syndrome. Remission was achieved with cyclophosphamide, corticosteroids, and pseudoaneurysm resection and maintained with infliximab and methotrexate.
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Affiliation(s)
- D. Sofia Villacis-Nunez
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Zachary West
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Adil Y. Khan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Fred Rodriguez
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Andi L. Shane
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Heather Rytting
- Department of Pathology, Children’s
Healthcare of Atlanta, Atlanta, GA, USA
| | - Subhadra Shashidharan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Congenital Cardiac
Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew S. Clifton
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Surgery, Emory University
School of Medicine, Atlanta, GA, USA
| | - Gary Woods
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Pediatrics, Emory
University School of Medicine, Atlanta, GA, USA
| | - Martha Clabby
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Sampath Prahalad
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Human Genetics, Emory
University School of Medicine, Atlanta, GA, USA
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15
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Sachdev G, Yadav S, Balakrishnan C, Nanavati R. Hughes-Stovin Syndrome: An Experience of Management of 3 Cases From a Tertiary Health Care Centre. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2023; 16:11795441231168648. [PMID: 37200981 PMCID: PMC10185861 DOI: 10.1177/11795441231168648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/22/2023] [Indexed: 05/20/2023]
Abstract
Three young males with Hugh-Stovin's syndrome presented with cough, haemoptysis, fever, raised inflammatory markers, and pulmonary artery aneurysm. Only one had recurrent oral ulcers suggestive of Behcet's disease, and none were HLA B51 positive. All responded well to immunosuppression but eventually needed either an endovascular procedure or surgery.
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Affiliation(s)
- Girija Sachdev
- Girija Sachdev, Department of Rheumatology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
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16
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Giannessi C, Smorchkova O, Cozzi D, Zantonelli G, Bertelli E, Moroni C, Cavigli E, Miele V. Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement. Diagnostics (Basel) 2022; 12:2868. [PMID: 36428928 PMCID: PMC9689730 DOI: 10.3390/diagnostics12112868] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.
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Affiliation(s)
| | | | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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17
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Ragab Y, Emad Y, Rasker JJ. Comment on: Behçet's disease in Emergency Department: a rare case presenting with haemoptysis and massive pulmonary arterial aneurysms. On behalf of the Hughes-Stovin syndrome (HSS) international study group. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2022; 39:e2022004. [PMID: 35494171 PMCID: PMC9007025 DOI: 10.36141/svdld.v39i1.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/26/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J. Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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18
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Hughes-Stovin syndrome (HSS): current status and future perspectives. Clin Rheumatol 2021; 40:4787-4789. [PMID: 34655003 DOI: 10.1007/s10067-021-05958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
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