1
|
Thoracic Complications in Behçet's Disease: Imaging Findings. Can Respir J 2020; 2020:4649081. [PMID: 32566055 PMCID: PMC7275231 DOI: 10.1155/2020/4649081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.
Collapse
|
2
|
Mahmoud S, Ghosh S, Farver C, Lempel J, Azok J, Renapurkar RD. Pulmonary Vasculitis: Spectrum of Imaging Appearances. Radiol Clin North Am 2016; 54:1097-1118. [PMID: 27719978 DOI: 10.1016/j.rcl.2016.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pulmonary vasculitis is a relatively uncommon disorder, usually manifesting as part of systemic vasculitis. Imaging, specifically computed tomography, is often performed in the initial diagnostic workup. Although the findings in vasculitis can be nonspecific, they can provide important clues in the diagnosis, and guide the clinical team toward the right diagnosis. Radiologists must have knowledge of common and uncommon imaging findings in various vasculitides. Also, radiologists should be able to integrate the clinical presentation and laboratory test findings together with imaging features, so as to provide a meaningful differential diagnosis.
Collapse
Affiliation(s)
- Shamseldeen Mahmoud
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Subha Ghosh
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Carol Farver
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jason Lempel
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Joseph Azok
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rahul D Renapurkar
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
3
|
Edrees A, Naguib S, El Menyawi M, Ismail I, Nagah H. Pulmonary manifestations in a group of patients with Behcet's disease. Int J Rheum Dis 2015; 20:269-275. [PMID: 26354676 DOI: 10.1111/1756-185x.12626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In this study we investigated the frequency and characteristics of pulmonary manifestations in a group of patients with Behcet's disease (BD) who were admitted to Cairo University Hospital. METHODS Fifteen patients were included in our study, 14 men (93.3%) and one woman (6.66%).Their mean age was 30.06 ± 9.8 years and the mean age of onset of BD was 23.7 ± 5.54 years. All patients were subjected to full history taking, clinical examination, plain chest X-ray and helical computed tomography (CT) study of the chest. RESULTS Pulmonary involvements were detected in 11 patients with BD, 73.3% of cases: 10 men (90.9%) and one woman (9.09%).Their mean age was 28.8 ± 8.07, the mean age of onset of BD was 23.2 ± 5.59 years and the mean disease duration until lung manifestations appear was 3.7 ± 4.8 years. The main pulmonary and constitutional symptoms in these 11 patients were as follows: dyspnea 81.8%, cough 63.6%, weight loss 63.6%, chest tightness 54.5%, hemoptysis 45%, massive hemoptysis 27.2%, fever 36.3% and expectoration 36.3. Analysis of both vascular and parenchymal lung lesions in helical CT scan in the 11 patients with BD were as follows: pulmonary artery aneurysm (PAA) occurred in 5/11 patients (45.4%), pulmonary nodules occurred in 3/11 patients (27.2%), pleural effusion occurred in 3/11 patients (27.2%), pulmonary embolism and infarction occurred in 1/11 patients (9.09%) and pneumonitis occurred in 1/11 patients (9.09%). CONCLUSION The higher frequency of pulmonary manifestations in our patients (73.3%) and the higher frequency of PAA (33.3%) could be related to the fact that this study was conducted on a group of patients who were admitted to the hospital with more severe illnesses.
Collapse
Affiliation(s)
- Amr Edrees
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sherif Naguib
- Department of Internal Medicine, Cairo University, Cairo, Egypt
| | | | - Ihab Ismail
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Hamdy Nagah
- Department of Internal Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
4
|
Naguib SM, El Menyawi MM, Nabih MI, Ismail I. Pulmonary manifestations in a group of patients with Behçet’s disease. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2015. [DOI: 10.4103/1110-7782.155827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Abstract
Pulmonary artery aneurysms (PAAs) are the most common type of pulmonary involvement in Behçet's disease. However, the relationships between clinical features and prognosis have not been sufficiently evaluated. This article describes the results of a comprehensive review, revealing that PAAs have a predilection for hemoptysis manifestations, increased dimensions, right lower lobar location, multiplicity and concurrent intramural thrombus formation. Surgical intervention was needed in one third of patients. Patients with massive hemoptysis and PAA rupture warranted emergency operations. Conservatively treated patients were prone to PAA progression; interventional embolization was associated with higher risks of recurrence and reintervention for PAAs; and surgically treated patients exhibited the highest mortality rates. In conclusion, PAAs in Behçet's disease are characterized by a predilection for hemoptysis manifestations, right lower lobar location, multiplicity, and concurrent intramural thrombus formation. Both the condition itself and the surgical operations it warrants are linked with high mortality due to PAA hemorrhage.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Fujian Medical University, People's Republic of China
| |
Collapse
|
6
|
Zhang X, Dai H, Ma Z, Yang Y, Liu Y. Pulmonary involvement in patients with Behçet's disease: report of 15 cases. CLINICAL RESPIRATORY JOURNAL 2014; 9:414-22. [PMID: 24761807 DOI: 10.1111/crj.12153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/08/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Behçet's disease (BD) is a multisystem vasculitis, and pulmonary involvement in BD can have complex clinical manifestations. We aimed to analyze the clinical and radiological features, as well as the outcomes, of BD patients with pulmonary manifestation. METHOD We retrospectively reviewed the medical records of 106 patients with BD diagnosed in our institute between January 2000 and January 2013. Patients with pulmonary vascular or parenchymal abnormalities on chest radiography, thorax computed tomography, magnetic resonance imaging or pulmonary scintigraphy were included in this study. RESULTS Fifteen patients (14%) were identified to have pulmonary involvement. Pulmonary artery aneurysms (PAA) was observed in six patients, and all of them had concomitant thrombi, attenuation or occlusion of PAs, and five of them also had radiographic parenchymal changes. Three patients had solely pulmonary artery thrombus (PAT) without PAA. For the six patients with isolated radiographic parenchyma changes, pulmonary infiltration resolved with immunosuppressant therapy in four subjects; the lesion remained unchanged in one subject with radiographic interstitial changes, and acid-fast bacilli were found in the remaining subject. Patients with PAA or PAT had more frequency of hemoptysis and extra-pulmonary vascular lesions compared with isolated parenchymal involvement. Radiographic parenchyma changes are nonspecific, with ill-defined ground-glass opacity being the most common pulmonary radiographic parenchymal changes. Patients with isolated parenchymal changes had better prognosis than those with PAA or PAT. CONCLUSIONS BD with pulmonary involvement can have a wide spectrum of abnormal clinical and radiographic manifestations, and multiple pulmonary lesions can exit in the same patient.
Collapse
Affiliation(s)
- Xiaolei Zhang
- Pulmonary and Critical Care Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huaping Dai
- Pulmonary and Critical Care Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhanhong Ma
- Pulmonary and Critical Care Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanhua Yang
- Pulmonary and Critical Care Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Pulmonary and Critical Care Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Noninfectious Inflammatory Lung Disease: Imaging Considerations and Clues to Differential Diagnosis. AJR Am J Roentgenol 2013; 201:278-94. [DOI: 10.2214/ajr.12.9772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
8
|
A Behcet's Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism. Case Rep Pulmonol 2013; 2013:492321. [PMID: 23853733 PMCID: PMC3703321 DOI: 10.1155/2013/492321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/04/2013] [Indexed: 11/30/2022] Open
Abstract
Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet's disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT) obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet's disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2 × 1.6 cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet's disease.
Collapse
|
9
|
|
10
|
Bilgin G, Sungur G, Kucukterzi V. Systemic and pulmonary screening of patients with Behçet's disease during periodic follow-up. Respir Med 2013; 107:466-71. [DOI: 10.1016/j.rmed.2012.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 10/27/2022]
|
11
|
Restrepo CS, Carswell AP. Aneurysms and Pseudoaneurysms of the Pulmonary Vasculature. Semin Ultrasound CT MR 2012; 33:552-66. [DOI: 10.1053/j.sult.2012.04.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
12
|
Seyahi E, Melikoglu M, Akman C, Hamuryudan V, Ozer H, Hatemi G, Yurdakul S, Tuzun H, Oz B, Yazici H. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients. Medicine (Baltimore) 2012; 91:35-48. [PMID: 22210555 DOI: 10.1097/md.0b013e318242ff37] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pulmonary artery aneurysms (PAAs) are well known causes of mortality and morbidity in Behçet disease (BD). However, pulmonary artery involvement in BD is not limited to PAA; the other main type of pulmonary artery involvement is pulmonary artery thrombus (PAT), with or without associated PAA. In addition, other types of lung disease like nodules and cavities in the lung parenchyma are frequently associated with pulmonary artery involvement, and can be misinterpreted as being due to infection. We surveyed the clinical, radiologic, and laboratory characteristics and outcome of 47 BD patients with pulmonary artery involvement and the associated findings, all seen and followed at a single dedicated tertiary care center.We identified 47 (41 male, 6 female) patients in whom pulmonary artery involvement was diagnosed, who were registered in the multidisciplinary clinic at Cerrahpasa Medical Faculty between January 2000 and December 2007. Mean age at diagnosis was 29 ± 8 years, and mean disease duration to the onset of pulmonary artery involvement was 3.6 ± 4.8 years. Hemoptysis was the most common presenting symptom (79%) followed by cough, fever, dyspnea, and pleuritic chest pain. Thirty-four of 47 patients (72%) presented with PAA, including 8 with associated PAT. The remaining 13 patients (28%) had isolated PAT. Patients with isolated PAT in general have clinical features similar to patients with PAA. However, hemoptysis was less frequent and voluminous in patients with isolated PAT. Most (91%) of the patients had active disease outside the lungs when they presented with pulmonary artery involvement.Forty (85%) patients had nodules and 6 (13%) had cavities when first seen. Peripheral venous thrombosis was present in 36 of 47 (77%) patients, and intracardiac thrombi in 12 of the 36 (33%) patients. Nodules, cavities, and intracardiac thrombi were mainly present in the acute stages of pulmonary artery involvement.Pulmonary artery involvement is usually multiple, and involves mostly descending branches of the pulmonary artery. Pulmonary artery involvement may disappear, but arterial stenosis or occlusions usually develop at the same location. After a mean follow-up of 7 years, 12 of 47 (26%) patients were dead; patients with larger aneurysms were more likely to die. Sixteen of 47 (34%) patients were symptom free, and the remaining 40% had mild dyspnea (13/47) and/or small bouts of hemoptysis (8/47).Pulmonary artery pressure may be elevated, and may indicate a poor prognosis. Mediastinal lymphadenopathy and mild pleural and pericardial effusions may also be observed. Corticosteroids and immunosuppressive agents are the mainstays of treatment; however, refractory cases may require embolization, lobectomy, cavitectomy, and decortication.
Collapse
Affiliation(s)
- Emire Seyahi
- From Division of Rheumatology (ES, MM, VH, GH, SY, HY); Department of Radiology (CA, HO); Department of Cardiovascular Surgery (HT); and Department of Pathology (BO); Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Chrastina A, Schnitzer JE. Laser-targeted photosensitizer-induced lung injury: noninvasive rat model of pulmonary infarction. Exp Lung Res 2011; 38:1-8. [PMID: 22122508 DOI: 10.3109/01902148.2011.627085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pulmonary infarction is a life-threatening lung injury that requires rapid and accurate diagnosis for proper treatment. Targetable and reproducible small-animal models that would allow experimental development and preclinical evaluation of diagnostic methods for detecting pulmonary infarction are critically missing. The authors report here a novel procedure to selectively induce pulmonary infarction by photodestructive laser-light irradiation in a targeted location within a specific lung compartment after administration of a photosensitizer. Histopathological analysis of the illuminated lung tissue revealed massive hemorrhage and vascular occlusion after acute injury localized to the site of irradiation. Collapse of alveolar structure, neutrophil influx, and necrosis were subsequently observed. Computed tomography (CT) scans showed evidence of abnormal density and airspace consolidation in the irradiated area of the lung, but not elsewhere in the lung compartment. Perfusion imaging using 99mTc-labeled macroaggregated albumin by single-photon emission computed tomography revealed diminished scintigraphic signal in the opaque area of infarcted lung tissue. The histological changes, CT findings, and perfusion characteristics of pulmonary infarction are mimicked using laser-irradiated, photosensitizer-mediated photodestruction to selectively induce chronic lung injury in a localized area. This small-animal model can be easily and readily used for targeted induction of pulmonary infarction in a designated area of lung compartment and offers the potential for use in evaluating novel diagnostic and therapeutic methods.
Collapse
Affiliation(s)
- Adrian Chrastina
- Proteogenomics Research Institute for Systems Medicine, San Diego, California 92121, USA
| | | |
Collapse
|
14
|
Agha A, Bella AME, Assiri AHM, Al-Hakami M. Can Behcet's Disease Related Pulmonary Arterial Aneurysms be Completely Resolved? Open Rheumatol J 2011; 5:88-90. [PMID: 22216070 PMCID: PMC3245488 DOI: 10.2174/1874312901105010088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/28/2011] [Accepted: 10/31/2011] [Indexed: 12/04/2022] Open
Abstract
Behçet disease is a systemic disease with diverse clinical symptoms which include, but not limited to, patients having oral and genital ulcers and eye involvement. We here report an 18-year-old male presenting with massive hemoptysis and cardiac arrest, having history of ulcers in the oral cavity and genitalia as well as having recent episode of uveitis. A pulmonary CT angiography revealed bilateral arterial aneurysms of pulmonary vessels. On receiving Immunosuppressive treatment for Behcet disease with prednisone and azathioprine over one year the pulmonary arterial aneurysms were completely resolved and the patient was discharged from the hospital albeit with persistent hypoxic brain injury from cardiac arrest.
Collapse
Affiliation(s)
- Adnan Agha
- Armed Forces Hospital Southern Region, Khamis Mushyt, Kingdom of Saudi Arabia
| | | | | | | |
Collapse
|
15
|
Pulmonary and Vascular Manifestations of Behçet Disease: Imaging Findings. AJR Am J Roentgenol 2010; 194:W158-64. [DOI: 10.2214/ajr.09.2763] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Santana ANC, Antunes T, Barros JMD, Kairalla RA, Carvalho CRRD, Barbas CSV. [Pulmonary involvement in Behcet's disease: a positive single-center experience with the use of immunosuppressive therapy]. J Bras Pneumol 2008; 34:362-6. [PMID: 18622502 DOI: 10.1590/s1806-37132008000600005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Behcet's syndrome, or Behcet's disease (BD), is a multisystem pathology, and survival is related to pulmonary involvement. However, it appears that different treatments correlate with different prognoses. The aim of this study was to evaluate clinical and tomographic evolution, as well as the survival, of patients with BD-related pulmonary involvement. METHODS A retrospective review of our experience with pulmonary manifestations in patients with BD treated at our institution between January 1, 1988 and April 30, 2006. The clinical, radiological, treatment and survival data were obtained from medical charts. RESULTS We identified 9 patients with BD-related pulmonary involvement. The mean age was 34 +/- 11.5 years, and 7 of the patients were male. The radiological findings were as follows: pulmonary artery aneurysm (PAA) in 8 patients; pulmonary embolism in 3 (translating to an incidence of 5.11 cases/100 patient-years); alveolar hemorrhage in one; and pulmonary hypertension in one. The treatment consisted of immunosuppression with prednisone plus chlorambucil (or cyclophosphamide or mycophenolate mofetil) in all patients, with partial or complete resolution of the PAAs. One patient with a PAA and pulmonary hypertension also received sildenafil and warfarin, with good clinical and tomographic response (the first report in the English literature). In our sample, the mean duration of the follow-up period was 6.52 years. The three-year survival rate was 88.8%, as was the five-year survival rate. CONCLUSIONS Patients with BD-related pulmonary involvement can present good survival with immunosuppressive therapy, and BD should be borne in mind as a possible cause of pulmonary hypertension and alveolar hemorrhage.
Collapse
|
17
|
Chae EJ, Do KH, Seo JB, Park SH, Kang JW, Jang YM, Lee JS, Song JW, Song KS, Lee JH, Kim AY, Lim TH. Radiologic and clinical findings of Behçet disease: comprehensive review of multisystemic involvement. Radiographics 2008; 28:e31. [PMID: 18603663 DOI: 10.1148/rg.e31] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Behçet disease is a chronic, relapsing, systemic disorder of unknown etiology, characterized by recurrent oral and genital ulcers, uveitis, and other clinical manifestations in multiple organ systems. Although the diagnosis is made on the basis of the combination of typical clinical symptoms, radiologic findings of Behçet disease show characteristic features of its involvement in the gastrointestinal, neurologic, cardiovascular, and thoracic organ systems. In the gastrointestinal tract, Behçet disease may produce various types of ulcers in the esophagus, stomach, and small and large intestines, as well as deeply penetrating ulcerations in the ileocecal region, with frequently accompanying enteric fistulas. Neurologic involvement includes typical and atypical parenchymal neurobehcet disease, dural sinus thrombosis, cerebral arterial aneurysm, occlusion, dissection, and meningitis. Vascular involvement is divided into three subsets including venous occlusion, arterial occlusion, and arterial aneurysm. Cardiac manifestations include intracardiac thrombus, endomyocardial fibrosis, periaortic pseudoaneurysm, and rupture of the sinus of Valsalva. Manifestations of Behçet disease in the thorax include pulmonary arterial aneurysm, pulmonary arterial thromboembolism, thrombosis in the superior vena cava, pulmonary infarction, hemorrhage, and vasculitis of the pleura and pericardium. These various manifestations of Behçet disease respond to steroid treatment; however, one of the characteristics of Behçet disease is the high rate of complications and recurrence after surgery. Familiarity with its various radiologic and clinical characteristics is essential in making an accurate early diagnosis and for prompt treatment of patients with Behçet disease.
Collapse
Affiliation(s)
- Eun Jin Chae
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul 138-736, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Celenk C, Aydin F, Unsal M. Pulmonary alterations in Behcet's disease. Eur J Radiol 2008; 70:317-9. [PMID: 18337040 DOI: 10.1016/j.ejrad.2008.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 01/11/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to demonstrate pulmonary alterations (PA) in patients with Behcet's disease by using CT. MATERIALS AND METHODS CTs of 50 patients with Behcet's disease and 20 others in a control group have been evaluated retrospectively for PA (septal, reticular, nodular, atelectatic opacities). RESULTS Eight out of 50 patients (16%) with Behcet's disease showed PA. Three out of 20 (15%) in the control group showed PA. No differences were observed between Behcet's disease patients and the control group regarding pulmonary alterations (p=0.917). No differences were observed in the disease duration, ages and sex in either group in those with and without PA. CONCLUSION Pulmonary alterations can be seen in patients with Behcet's disease, but these alterations are not significant.
Collapse
Affiliation(s)
- Cetin Celenk
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Tip Fakültesi, Radyoloji, Samsun, Turkey.
| | | | | |
Collapse
|
19
|
Kanne JP, Mohammed TLH. Fibrosing mediastinitis associated with Behçet's disease: CT findings. Clin Radiol 2007; 62:1124-6. [PMID: 17920874 DOI: 10.1016/j.crad.2007.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 05/31/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Jeffrey P Kanne
- Section of Thoracic Imaging, Division of Radiology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | |
Collapse
|
20
|
Chung JW. Radiological Intervention for Pulmonary Vasculature. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.62.5.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Ech-Cherif El Kettani N, Dafiri R. [Hemoptysis revealing a pulmonary arterial aneurysm on Behçet disease in children: role of computed tomography]. JOURNAL DE RADIOLOGIE 2006; 87:1093-5. [PMID: 16936633 DOI: 10.1016/s0221-0363(06)74133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Behçet's disease is a systemic condition whose discovery during hemoptysis on a pulmonary artery aneurysm is rare, especially in children. Through the case of a 11-year-old boy, the authors emphasize the importance of imaging in diagnosis of this disease, whose progression can be fatal if hemoptysis is violent.
Collapse
|
22
|
|
23
|
Abstract
STUDY OBJECTIVES The aims of this study were to investigate the frequency of pulmonary problems in Behçet disease (BD), and to discuss lesser-known features of pulmonary BD such as clinical characteristics, analysis of prognosis, and evaluation of treatment options with respect to the previously published cases. DESIGN We conducted a comprehensive review of the literature to analyze cumulated data about pulmonary involvement in BD. SETTING We found 159 articles regarding pulmonary disease associated with BD in May 2003. PATIENTS The evaluation of these articles demonstrated 598 pulmonary problems in 585 cases. RESULTS Pulmonary artery aneurysms (PAAs) are the most common pulmonary lesion in BD, and these are almost always associated with hemoptysis. Seventy-eight percent of patients with aneurysms have concomitant extrapulmonary venous thrombi or thrombophlebitis. Other pulmonary problems are reported in BD, and these are principally related to vascular lesions and radiologic abnormalities. CONCLUSIONS Pulmonary vascular problems, either PAA or involvement of small-sized vessels, are the main pulmonary disorders in BD. Immunopathologic findings indicate that the underlying pathogenesis is pulmonary vasculitis, which may result in thrombosis, infarction, hemorrhage, and PAA formation. Patients with small nonspecific radiologic abnormalities should be followed up closely since early diagnosis of vascular lesions may be life-saving. Immunosuppression is the main therapy for the treatment of a vasculitis. It is important that pulmonary angiitis is not mistaken for pulmonary thromboembolic disease since fatalities have occurred in BD shortly after initiation of anticoagulation/thrombolytic treatment.
Collapse
Affiliation(s)
- Oguz Uzun
- Department of Pilmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Tip Fak, Göğüs Hst. ABD 55139, Kurupelit-Samsun, Turkey.
| | | | | |
Collapse
|
24
|
Kim HK, Yong HS, Oh YW, Shim JJ, Kim HK, Kang EY. Behçet Disease Complicated by Diffuse Alveolar Damage. J Thorac Imaging 2005; 20:55-7. [PMID: 15729125 DOI: 10.1097/01.rti.0000139392.33761.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an extremely rare case of Behçet disease complicated by diffuse alveolar damage, which was fatal in this patient. It manifested as progressive diffuse ground-glass attenuation in both lungs on chest radiographs and high-resolution CT. Ground-glass attenuation was confirmed histopathologically as diffuse alveolar damage without identified etiology by open lung biopsy.
Collapse
Affiliation(s)
- Hee-Kyung Kim
- Department of Diagnostic Radiology, College of Medicine, Korea University, Korea University Guro Hospital, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Abstract
Our knowledge about pulmonary complications of Behçet's disease continues to evolve, but we need controlled trials for the management of the disease. The main goal should be to elucidate the pathogenesis and standardize the management according to the underlying pathologic process.
Collapse
Affiliation(s)
- Feyza Erkan
- Department of Pulmonary Medicine, Istanbul Medical Faculty, University of Istanbul, 34 390 Capa-Istanbul, Turkey.
| | | | | |
Collapse
|
27
|
Affiliation(s)
- B T Nguyen
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| |
Collapse
|
28
|
Rockall AG, Rickards D, Shaw PJ. Imaging of the pulmonary manifestations of systemic disease. Postgrad Med J 2001; 77:621-38. [PMID: 11571369 PMCID: PMC1742125 DOI: 10.1136/pmj.77.912.621] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A G Rockall
- Department of Radiology, University College London Hospitals, London, UK
| | | | | |
Collapse
|
29
|
|
30
|
Affiliation(s)
- F Erkan
- Division of Pneumology, Istanbul Medical Faculty, University of Istanbul, Turkey.
| | | | | |
Collapse
|
31
|
|
32
|
Seo JB, Im JG, Chung JW, Song JW, Goo JM, Park JH, Yeon KM. Pulmonary vasculitis: the spectrum of radiological findings. Br J Radiol 2000; 73:1224-31. [PMID: 11144805 DOI: 10.1259/bjr.73.875.11144805] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary vasculitis includes various disease entities with a wide range of clinical presentations and overlapping imaging features. Radiological findings of vasculitis in the angiitis-granulomatosis group are nodular and patchy opacities, whereas the principal feature of those diseases causing widespread capillaritis is diffuse air space consolidation. Aneurysms or stenoses of pulmonary arteries are seen in patients with Takayasu arteritis or Behçet's disease.
Collapse
Affiliation(s)
- J B Seo
- Department of Radiology, Gachon Medical School, Gil Medical Center, 1198, Kuwol-dong, Namdong-gu, Inchon 405-220, South Korea
| | | | | | | | | | | | | |
Collapse
|
33
|
Gül A, Yilmazbayhan D, Büyükbabani N, Lie JT, Tunaci M, Tunaci A, Inanç M, Ocal L, Aral O, Koniçe M. Organizing pneumonia associated with pulmonary artery aneurysms in Behçet's disease. Rheumatology (Oxford) 1999; 38:1285-9. [PMID: 10587562 DOI: 10.1093/rheumatology/38.12.1285] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- A Gül
- Division of Rheumatology, Department of Internal Medicine, Department of Pathology and Department of Radiology, Istanbul School of Medicine, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. As a minimally invasive examination, this technique is becoming widely available and has progressively replaced conventional and digital pulmonary angiography as the standard diagnostic imaging modality of the pulmonary circulation. The purpose of this review is to capture the current state of the art of the technical aspects of spiral CT angiography, with special emphasis on the post-processing techniques currently available. As CT is responsible for a considerable part of the medical radiation dose applied to the population, the current trends for dose saving will also be emphasized. With regard to the clinical applications of spiral CT angiography, its introduction into the diagnostic work-up of pulmonary embolism has considerably modified the diagnostic algorithms. Our 8-year review of the literature presented herein is expected to provide the readers with a basis for formulating an informed opinion on this topic. In addition, a large number of congenital and acquired disorders of the pulmonary circulation are also relevant to this technique, and these indications are discussed in the context of the corresponding therapeutic options. Owing to the multiple possibilities inherent to this technique, spiral CT has the potential for cost savings without reduction in image quality or diagnostic accuracy.
Collapse
Affiliation(s)
- M Remy-Jardin
- Department of Radiology, Hospital Calmette, Lille, France.
| | | |
Collapse
|
35
|
Sraieb T, Ben Romdhane N, Longo S, Manaa J, Louzir B, Othmani S. [Arterial aneurysms and Behçet's disease: apropos of 3 cases]. Rev Med Interne 1999; 20:517-21. [PMID: 10422144 DOI: 10.1016/s0248-8663(99)80087-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Results that were obtained from three patients and a literature review allow the authors to better define the place of medical and surgical treatments according to the different locations of arterial aneurysm occurring in the course of Behcet's disease. METHODS Retrospective report of five cases of arterial aneurysm that occurred during Behcet's disease in three patients. RESULTS Due to the unusual symptoms, diagnosis can be hampered. Though lesions may be observed in various areas, they were mostly aortic (two patients). Surgical revascularization was done in all three patients. It mainly involved prosthetic grafts. Two patients were subsequently treated by postoperative immunosuppressive drugs. The mean follow-up was 22 months. Relapsing aneurysm was observed in one patient, while in another patient aneurysm developed in a new location. CONCLUSION These types of arterial lesions respond poorly to medical treatment when a combination of colchicine and intermittent intravenous bolus of cyclophosphamide is used. Surgical indications should be given great yet selected weight, using prosthetic rather than venous autologous grafts (due to the risk of spontaneous venous involvement). Since either complication or recurrence is possible, prolonged monitoring is required.
Collapse
Affiliation(s)
- T Sraieb
- Service de chirurgie vasculaire et de transplantation d'organes, hôpital militaire principal de Tunis, Mont Fleury Tunis, Tunisie
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
Pulmonary vascular inflammation may be seen in a variety of primary lung diseases and in the setting of numerous systemic illnesses. This article reviews those entities in which pulmonary vasculitis represents a central feature of the pathologic process (Wegener's granulomatosis, Churg-Strauss syndrome, and pulmonary capillaritis). In addition, features of pulmonary involvement in other systemic vasculitides (Giant Cell Arteritis, Takayasu's Arteritis, and Behçet's disease) are described. Finally, general principles for the treatment of vasculitis are reviewed.
Collapse
Affiliation(s)
- E J Sullivan
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Ohio, USA
| | | |
Collapse
|
37
|
Abstract
Behçet's syndrome is a multi-systemic and chronic disorder that affects many organs. It has been suggested that the diagnosis was based on the presence of the 'major' and 'minor' clinical criteria. When thromobophlebitis, arthritis, central nervous system or gastrointestinal lesions are also present. Behçet's syndrome will be thought to be present in the appropriate geographic area. We report a case of superior vena cava syndrome caused by Behçet's disease in a 40-year-old man with recurrent oral aphthous ulcers and skin rashes on the anterior chest wall. There were multiple thrombosis of the superior vena cava, innominate and subclavian veins. This patient also had a solitary cecal ulcer with an ileocecal fistula and downhill varix. The chest CT, veno-cavography, pulmonary angiography and colon study were taken and follow-up was performed.
Collapse
Affiliation(s)
- D S Han
- Department of Internal Medicine, Radiology Hanyang University Kuri Hospital, Korea
| | | | | | | | | | | |
Collapse
|
38
|
Kröger K, Ansasy M, Rudofsky G. Postoperative thrombosis of the superior caval vein in a patient with primary asymptomatic Behçet's disease. A case report. Angiology 1997; 48:649-53. [PMID: 9242164 DOI: 10.1177/000331979704800713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Behçet's disease is a systemic vasculitis of unknown cause. In 1937 Behçet described 3 patients with oral and genital ulceration and hypopyon iritis. The disease shows worldwide distribution with the highest prevalence in the eastern Mediterranean region and Japan. The most common manifestation is recurrent oral ulceration. Other manifestations include genital ulceration, eye lesions, skin lesion, arthritis or arthralgia, and cerebral lesions. Venous thrombosis and thrombophlebitis are also recorded as manifestations. One of the causes of superior caval vein obstruction is Behçet's disease. Especially in Turkey, this association is common. Management must be directed against the primary disease plus the caval vein obstruction. The authors describe a patient with multisymptomatic presentation of Behçet's disease with thrombosis of the superior caval veins and successful lysis with streptokinase.
Collapse
Affiliation(s)
- K Kröger
- Klinik für Angilogie, Kliniken Essen, Germany
| | | | | |
Collapse
|
39
|
|