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Ascoli Marchetti A, Belvivere L, Argirò R, Kroegler B, Oddi FM, Pennetta F, Giorgi AD, Fazzini S, Morosetti D, Triggianese P, Greco E, D'Antonio A, Coccia I, Tesauro M, Sangiuolo F, Ippoliti A. A Rare but Fatal Behçet Variant: The Hughes-Stovin Syndrome-Successful Case Report and New Evidence from Literature Review. AORTA (STAMFORD, CONN.) 2023; 11:156-161. [PMID: 38531384 PMCID: PMC11038734 DOI: 10.1055/s-0043-1777994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/18/2023] [Indexed: 03/28/2024]
Abstract
Hughes-Stovin syndrome (HSS) is a rare potentially fatal vasculitis supposedly belonging to the spectrum of Behçet disease without ocular involvement. HSS tends to play by a temporal pattern, starting with thrombosis and followed by formation of pulmonary aneurysms. Since its mortality can reach 25% of cases, early recognition and appropriate therapy represent the major clinical challenges. We describe a rare case of HSS successfully treated via multidisciplinary management by an endovascular approach and immunosuppressive therapy.
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Affiliation(s)
- Andrea Ascoli Marchetti
- Biomedicine and Prevention Department, Vascular Surgery Unit, University of Rome Tor Vergata, Rome, Italy
| | - Lorella Belvivere
- Cardiac Surgery, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Renato Argirò
- Radiology Department, Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Kroegler
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Fabio M. Oddi
- Biomedicine and Prevention Department, Vascular Surgery Unit, University of Rome Tor Vergata, Rome, Italy
| | - Federico Pennetta
- Biomedicine and Prevention Department, Vascular Surgery Unit, University of Rome Tor Vergata, Rome, Italy
| | - Alice de Giorgi
- Biomedicine and Prevention Department, Vascular Surgery Unit, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Fazzini
- Biomedicine and Prevention Department, Vascular Surgery Unit, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Morosetti
- Radiology Department, Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Elisabetta Greco
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Arianna D'Antonio
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Coccia
- Department of “Medicina dei Sistemi,” Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Manfredi Tesauro
- Department of “Medicina dei Sistemi,” Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federica Sangiuolo
- Biomedicine and Prevention Department, Medical Genetics, University of Rome Tor Vergata, Italy
| | - Arnaldo Ippoliti
- Biomedicine and Prevention Department, Vascular Surgery Unit, University of Rome Tor Vergata, Rome, Italy
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Yalçın S, Ensarioglu K, Kurt B, Özişler C. Hughes-Stovin Syndrome: A Rare Cause of Thrombosis and Pulmonary Artery Aneurysm. Cureus 2023; 15:e37121. [PMID: 37153244 PMCID: PMC10159220 DOI: 10.7759/cureus.37121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Hughes-Stovin Syndrome (HSS) is a rare clinical condition characterized by thrombophlebitis as well as multiple pulmonary and bronchial aneurysms. It commonly presents with coughing, dyspnea, fever, chest pain, and hemoptysis, and its management usually consists of surgical and medical approaches. In this report, we discuss a case of a patient with HSS. A 30-year-old male patient was admitted to the pulmonary medicine ward for hemoptysis. After evaluation with chest CT, bilateral pulmonary embolism and pulmonary aneurysms were observed. Due to a history of aphthous lesions, Behçet's disease (BD) was considered the initial diagnosis; however, the patient did not fit the criteria and was later diagnosed with HSS. Intravenous methylprednisolone was initiated, along with a maintenance treatment with cyclophosphamide. Treatment response was observed in the fourth month; however, due to the persistence of hemoptysis, additional cycles of cyclophosphamide were later required, under which the patient's condition has been stable. HSS currently lacks clear diagnostic criteria, and further studies are needed to investigate genetic backgrounds, familial transmissions, and treatment alternatives.
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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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Emad Y, Ragab Y, Kechida M, Guffroy A, Kindermann M, Robinson C, Erkan D, Frikha F, Ibrahim O, Al-Jahdali H, Silva RS, Tornes L, Margolesky J, Bennji S, Kim JT, Abdelbary M, Fabi M, Hassan M, Cruz V, El-Shaarawy N, Jaramillo N, Khalil A, Demirkan S, Tekavec-Trkanjec J, Elyaski A, de FreitasRibeiro BN, Kably I, Al-Zeedy K, Jayakrishnan B, Ghirardo S, Barman B, Farber HW, Pankl S, Abou-Zeid A, Young P, Amezyane T, Agarwala MK, Bawaskar P, Hawass M, Saad A, Rasker JJ. A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG). Int J Cardiol 2021; 331:221-229. [PMID: 33529654 DOI: 10.1016/j.ijcard.2021.01.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hughes-Stovin syndrome (HSS) is a systemic disease characterized by widespread vascular thrombosis and pulmonary vasculitis with serious morbidity and mortality. The HSS International Study Group is a multidisciplinary taskforce aiming to study HSS, in order to generate consensus recommendations regarding diagnosis and treatment. METHODS We included 57 published cases of HSS (43 males) and collected data regarding: clinical presentation, associated complications, hemoptysis severity, laboratory and computed tomography pulmonary angiography (CTPA) findings, treatment modalities and cause of death. RESULTS At initial presentation, DVT was observed in 29(33.3 %), thrombophlebitis in 3(5.3%), hemoptysis in 24(42.1%), and diplopia and seizures in 1 patient each. During the course of disease, DVT occurred in 48(84.2%) patients, and superficial thrombophlebitis was observed in 29(50.9%). Hemoptysis occurred in 53(93.0%) patients and was fatal in 12(21.1%). Pulmonary artery (PA) aneurysms (PAAs) were bilateral in 53(93%) patients. PAA were located within the main PA in 11(19.3%), lobar in 50(87.7%), interlobar in 13(22.8%) and segmental in 42(73.7%). Fatal outcomes were more common in patients with inferior vena cava thrombosis (p = 0.039) and ruptured PAAs (p < 0.001). Death was less common in patients treated with corticosteroids (p < 0.001), cyclophosphamide (p < 0.008), azathioprine (p < 0.008), combined immune modulators (p < 0.001). No patients had uveitis; 6(10.5%) had genital ulcers and 11(19.3%) had oral ulcers. CONCLUSIONS HSS may lead to serious morbidity and mortality if left untreated. PAAs, adherent in-situ thrombosis and aneurysmal wall enhancement are characteristic CTPA signs of HSS pulmonary vasculitis. Combined immune modulators contribute to favorable outcomes.
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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
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, Monastir 5019, Tunisia
| | - Aurelien Guffroy
- Service d'immunologie clinique et médecine interne, centre de référence des maladies auto-immunes systémiques rares (RESO), hôpitaux universitaires de Strasbourg, nouvel hôpital civil, 67091 Strasbourg, France; UFR médecine Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany
| | - Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto ON, Canada
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Ashton Rd, Lancaster LA1 4RP, United Kingdom
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Leticia Tornes
- University of Miami Miller School of Medicine, Department of Neurology, Professional Arts Center, 1150 NW 14th St, Suite 609, Miami, FL 33136, United States
| | - Jason Margolesky
- University of Miami Miller School of Medicine, Department of Neurology, Professional Arts Center, 1150 NW 14th St, Suite 609, Miami, FL 33136, United States
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital/Stellenbosch University, Francie van Zijl Drive Tygerberg 7505, Cape Town, South Africa
| | - 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
| | - Mohamed Abdelbary
- Department of Radiology, Badr Hospital, Helwan University, 11790 Cairo, Egypt
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al kartoom square, al Azareta, Alexandria 21526, Egypt
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University,Ismailia 4.5 Km the Ring Road, 41522 Ismailia, Egypt
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de Hierro Majadahonda, C/Joaquin Rodrigo 3, Madrid 28222, Spain
| | - Antoine Khalil
- Radiology Department, Bichat-Claude Bernard Hospital, HUPNVS, APHP, Paris University, 46 rue Henri Huchard, 74018 Paris, United States of America
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Izmir Katip Çelebi University Faculty of Medicine, Karabağlar, Izmir, Turkey
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary medicine, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Ahmed Elyaski
- Department of prosthesis and orthosis technology Program, Faculty of Applied Health Sciences, Galala University 43511, Suez Governorate, Suez, Egypt
| | - B N de FreitasRibeiro
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, 20231-092 Rio de Janeiro, RJ, Brazil
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khalfan Al-Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, 123, Al-Khoud, Muscat, Oman
| | | | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127 Trieste, TS, Italy
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong 793018, Meghalaya, India
| | - H W Farber
- Tufts University School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, MA, United States
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Alaa Abou-Zeid
- Public health Department, Faculty of medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, School of Medicine, Rabat, Morocco
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad 500096, India
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair road, Mumbai 400008, Maharashtra, India
| | - Mona Hawass
- Nephrology Department, El Agouza Police Hospital, El Nil St. Agouza, Giza, Governorate, Egypt
| | - Ahmed Saad
- Internal medicine 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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Abstract
Anticoagulation in venous thrombosis associated with Behçet disease (BD) is controversial. We herein report a 47-year-old woman with vessel thrombosis and pulmonary artery aneurysm (PAA) associated with BD who died of massive hemoptysis under oral anticoagulant. Although she was initially diagnosed with oral contraceptive-induced venous thromboembolism, a subsequent investigation led to a diagnosis of BD. Follow-up computed tomography (CT) showed persistent thrombus, so anticoagulant was continued for persistent thrombus. She died of massive hemoptysis after the development of PAA was identified on follow-up CT during the period of anticoagulation. Great care to prevent bleeding events is required when administering anticoagulants for BD with vessel thrombosis.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Ryosuke Narui
- Department of Cardiology, The Jikei University School of Medicine, Japan
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Japan
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Touman A, Vitsas V, Leonidas A, Freitag L, Stratakos GK. Localized Bronchial Hyperemia in Cases of Iatrogenic Hemoptysis: Clinical Presentations and Pathophysiological Mechanisms. Respiration 2020; 99:431-440. [PMID: 31935732 DOI: 10.1159/000499053] [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: 01/11/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022] Open
Abstract
Hemoptysis is a frequently encountered symptom in many clinical settings, and etiologic diagnosis can sometimes prove challenging. Bronchoscopy may not promptly reveal the source or the cause of bleeding and few reports have focused so far on the abnormalities of bronchial mucosa vasculature that may unveil the underlying pathophysiology. In this special feature article, we present a series of cases presenting with hemoptysis after angiographic interventions in the thoracic vessels. Localized hyperemia and vascular dilatations in the bronchial mucosa observed during bronchoscopy as unique findings became clues enabling the correct diagnosis and management. We suggest the relevant pathophysiological mechanisms and discuss the available published experience on similar clinical entities.
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Affiliation(s)
- Abdelfattah Touman
- Pulmonology Section, Department of Medicine at Mouwasat Hospital, Dammam, Saudi Arabia,
| | - Vlasios Vitsas
- 1st Respiratory Medicine Department of the National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Grigoris K Stratakos
- 1st Respiratory Medicine Department of the National and Kapodistrian University of Athens, Athens, Greece
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A case of Hughes–Stovin syndrome (incomplete Behçet’s disease) with extensive arterial involvement. Z Rheumatol 2019; 78:365-371. [DOI: 10.1007/s00393-019-0618-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Dahi F, Keese M, Thalhammer A, Schmitz-Rixen T, Gkremoutis A. An Enigmatic Case of an Uncommon Syndrome: The Hughes-Stovin Syndrome. Ann Vasc Surg 2019; 60:474.e7-474.e10. [PMID: 30763701 DOI: 10.1016/j.avsg.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
Hughes-Stovin syndrome is a disorder characterized by deep vein thrombosis and pulmonary artery aneurysms with potentially life-threatening complications. The case of a 22-year-old Moroccan male patient, presenting with signs of sepsis of unclear etiology, is presented here. Computed tomography (CT) scan revealed thrombosis of the inferior vena cava up to the hepatic veins, thrombosis of both common iliac veins and a thrombus in the right atrium. Primarily suspecting septic thrombosis, surgical thrombectomy was performed. The patient recovered uneventfully and was discharged with oral anticoagulants. Three weeks later, he was admitted again with acute shortness of breath. A new CT scan showed bilateral pulmonary embolism and multiple pulmonary artery aneurysms. Hughes-Stovin syndrome was diagnosed, and high-dose heparin and an immunosuppressant (prednisolon) were administered. Two weeks later, the patient presented again with massive epistaxis and hemoptysis. A CT scan showed diffuse parenchymal bleeding. After prophylactic intubation and conservative treatment, he recovered rapidly and was again discharged uneventfully. Under immunosuppressants, a rapid reduction in the diameter of the pulmonary aneurysms was observed and the patient remained symptom-free during follow-up.
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Affiliation(s)
- Firouza Dahi
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt am Main, Frankfurt, Germany.
| | - Michael Keese
- Vascular Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Axel Thalhammer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Asimakis Gkremoutis
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt am Main, Frankfurt, Germany
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El Jammal T, Gavand PE, Martin M, Korganow AS, Guffroy A. Syndrome de Hughes-Stovin : à propos d’un cas chez un jeune patient avec thromboses récurrentes et anévrysme de l’artère pulmonaire et revue de la littérature. Rev Med Interne 2019; 40:120-125. [DOI: 10.1016/j.revmed.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 02/09/2023]
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Abdelbary M, El-Masry A, Rabie MS. Life threatening hemoptysis from Hughes Stovin syndrome: Is it that rare? Respir Med Case Rep 2016; 19:98-102. [PMID: 27642563 PMCID: PMC5018086 DOI: 10.1016/j.rmcr.2016.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Hughes-Stovin syndrome is a life-threatening disorder of unknown etiology. This condition is characterized by vasculitis, deep venous thrombosis and aneurysms that mainly involve the pulmonary arteries resulting in hemoptysis. It has been described in literature less than 40 times. However, we believe it is not very uncommon as it might be diagnosed as pulmonary embolism solely. In such cases, anticoagulation therapy augments the risk of life-threatening hemoptysis. Materials and methods We report the case of a 35 years old, Egyptian female patient with Hughes-Stovin syndrome, who initially presented with lower limb deep vein thrombosis and coughing of blood. Anticoagulation regimen for pulmonary embolism was given. This resulted in massive hemoptysis that was successfully controlled by medical therapy. Conclusion Adults who present with venous thrombosis and hemoptoic cough, with no predisposing factors of thrombosis, normal platelet count and coagulation, the possibility of Hughes-Stovin syndrome has to be considered.
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Affiliation(s)
- Mohammed Abdelbary
- Department of Radiology, Badr Hospital, Helwan University, Egypt
- Corresponding author.
| | - Ahmed El-Masry
- Department of Pulmonology, Specialized Hospital, Ainshams University, Egypt
| | - Motaz S. Rabie
- Department of Cardiothoracic Surgery, Badr Hospital, Helwan University, Egypt
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Di X, Ji DH, Chen Y, Liu CW, Liu B, Yang J. Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization: A case report and literature review. Medicine (Baltimore) 2016; 95:e4461. [PMID: 27583854 PMCID: PMC5008538 DOI: 10.1097/md.0000000000004461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention. METHODS This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA. RESULTS A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ test, P = 0.034). CONCLUSION Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA.
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Affiliation(s)
- Xiao Di
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Dong-Hua Ji
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Liaoning
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Chang-Wei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
- Correspondence: Bao Liu, Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing 100730, China (e-mail: )
| | - Juan Yang
- Department of Cytobiology, Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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12
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Mahmoud MI, Saadany A, Hassan M, Essam H. Case report: A rare cause of haemoptysis in a male with unprovoked deep venous thrombosis. Breathe (Sheff) 2016; 12:e12-9. [PMID: 27066146 PMCID: PMC4818239 DOI: 10.1183/20734735.010715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 29 year-old previously healthy Egyptian male complained of a 4-day vague abdominal pain for which he underwent an abdominal ultrasound. An inferior vena cava (IVC) thrombus was suspected by the sonographer who recommended undergoing an abdominal computed tomography (CT) with intravenous contrast. The IVC thrombus was confirmed by CT, but the study did not delineate any cause for the thrombus or any additional abdominal pathology. The basal chest scans revealed multiple peripheral cavitary nodules in both lower lung lobes. The patient was referred to our institution for evaluation of the pulmonary lesions. At the time, the patient only complained of an occasional cough and a small amount of mucopurulent sputum, but no chest pain. He was moderate smoker and substance abuser (tramadol and cannabis). The patient strongly denied i.v. drug abuse as well as taking any medications. A case report depicting a rare cause for the unusual entity of pulmonary artery aneurysmhttp://ow.ly/YvA1y
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Affiliation(s)
- Mahmoud I Mahmoud
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ayman Saadany
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Maged Hassan
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hatem Essam
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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13
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Paul A, Peringattuthodiyil Y, Christopher D, Thangakunam B. Young onset hemoptysis: A rare cause of pulmonary arterial aneurysm. Lung India 2016; 33:345-7. [PMID: 27186006 PMCID: PMC4857578 DOI: 10.4103/0970-2113.180952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Margolesky J, Tornes L, Vosoughi A. Transverse myelitis presenting in a patient with Hughes-Stovin syndrome. Mult Scler Relat Disord 2015; 4:281-3. [DOI: 10.1016/j.msard.2015.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/21/2015] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
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15
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Al-Zeedy K, Jayakrishnan B, Rizavi D, Alkaabi J. Hughes-stovin syndrome and massive hemoptysis: a management challenge. Oman Med J 2015; 30:59-62. [PMID: 25830003 DOI: 10.5001/omj.2015.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 03/01/2014] [Indexed: 11/03/2022] Open
Abstract
Hughes-Stovin syndrome is a very rare clinical entity characterized by pulmonary artery aneurysms and deep vein thrombosis (DVT). Here we report the case of a 53-year-old man, admitted to Sultan Qaboos University Hospital, Muscat, Oman, with bilateral pulmonary artery aneurysms and lower-limb DVT who developed massive hemoptysis. He was managed successfully with high-dose steroids in combination with cyclophosphamide.
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Affiliation(s)
- Khalfan Al-Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - B Jayakrishnan
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Dawar Rizavi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Juma Alkaabi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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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]
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17
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Abstract
Multiple pulmonary artery aneurysms are seen along with venous thrombosis in Hughes-Stovin syndrome, which many investigators believe is an incomplete form of Behcet's disease. We present a case of hemoptysis with multiple pulmonary artery aneurysms, femoral vein thrombosis, and oral ulcers with emphasis on its CT features.
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Affiliation(s)
- Naseer A Choh
- Department of Radiology, SMHS Hospital and Radiology SKIMS, Soura, Srinagar, India
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18
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Use of an amplatzer vascular plug in embolization of a pulmonary artery aneurysm in a case of hughes-stovin syndrome: a case report. J Med Case Rep 2011; 5:425. [PMID: 21884598 PMCID: PMC3184110 DOI: 10.1186/1752-1947-5-425] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 09/01/2011] [Indexed: 11/19/2022] Open
Abstract
Introduction Hughes-Stovin syndrome is a rare condition characterized by peripheral deep venous thrombosis accompanied by single or multiple pulmonary arterial aneurysms. The limited number of cases has precluded controlled studies of the management of pulmonary artery aneurysms, which usually cause massive hemoptysis leading to death. This is the first report of a new endovascular treatment of a single large pulmonary arterial aneurysm. Case presentation An 18-year-old Caucasian man was referred to our department with recurrent severe hemoptysis. His medical history included Hughes-Stovin syndrome diagnosed during a recent hospital admission. The patient was initially treated with corticosteroids. Because of his recurrent hemoptysis, we decided to embolize a 3.5 cm pulmonary arterial aneurysm using an Amplatzer Vascular Plug. The procedure was not complicated, and the patient's post-intervention course was uneventful. The patient has remained free from any complications of the embolization 36 months after the procedure. Conclusion Percutaneous embolization of a single large pulmonary artery aneurysm with an Amplatzer Vascular Plug in a patient with Hughes-Stovin syndrome is a less invasive procedure that represents the best multidisciplinary approach in treating these patients.
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Abstract
Hughes-Stovin Syndrome (HSS) is a very rare clinical disorder characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. Less than 40 published cases of HSS have been described in English medical literature so far. The exact etiology and pathogenesis of HSS is unknown; possible causes include infections and angiodysplasia. HSS has also been considered as a variant of Behcet's disease (BD). Patients with HSS usually present with cough, dyspnea, fever, chest pain and haemoptysis. The management of HSS can either be medical or surgical. Medical management includes the use of steroids and cytotoxic agents. Cyclophosphamide, in particular, is a favored therapeutic agent in this regard. Antibiotics have no proven role in HSS while anticoagulants and thombolytic agents are generally contraindicated due to an increased risk of fatal hemorrhage. However, their use may be considered with great care under special circumstances, for instance, intracardiac thrombi or massive pulmonary embolism. For cases of massive hemoptysis due to large pulmonary aneurysms or those with lesions confined to one segment or one lung, lobectomy or pneumectomy can be carried out. However, surgical risks merit serious consideration and must be discussed with the patient. Transcatheter arterial embolization has emerged as a less invasive alternative to surgery in selected cases of HSS. Overall, patients with HSS have a poor prognosis and aneurysmal rupture is the leading cause of death. However, early diagnosis and timely intervention is crucial in improving the prognosis. There is a need to clearly elucidate the genetic, etiologic and pathologic basis for HSS in the future. Although most of the evidence put forward to refute the role of an infectious agent in the etiology and pathogenesis of HSS is based on negative blood and other body fluid cultures, more robust objective assessment is needed through the use of electron microscopy or 16 sRNA studies. The development of better therapeutic agents is also needed to address and prevent the serious consequences arising from pulmonary arterial aneurysms seen in BD and HSS. Also, the issue of anticoagulation in these patients is challenging and requires further deliberation.
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Affiliation(s)
- Umair Khalid
- Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Taimur Saleem
- Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
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20
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Chalazonitis AN, Lachanis SB, Mitseas P, Argyriou P, Tzovara J, Porfyrides P, Sotiropoulou E, Ptohis N. Hughes-Stovin syndrome: a case report and review of the literature. CASES JOURNAL 2009; 2:98. [PMID: 19178695 PMCID: PMC2649053 DOI: 10.1186/1757-1626-2-98] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 01/29/2009] [Indexed: 11/23/2022]
Abstract
Background Hughes-Stovin syndrome is a rare entity. The aetiology of Hughes-Stovin syndrome is still unknown and the natural course of the illness is usually fatal; however it is supposed to be a clinical variant manifestation of Behçet disease. Case presentation We report the case of an 18 years old, greek male patient with Hughes-Stovin syndrome, who initially presented with deep vein thrombosis. There were no findings consistent with Behçet disease and the haemoptysis was treated successfully with methylprednisolone. Pathogenesis, imaging investigation and treatment of this syndrome are also briefly discussed. Conclusion In young men presenting with venous thrombosis as revealed on imaging examination, with platelet count and coagulation tests within normal and hemoptysis the eventuality of Hughes-Stovin syndrome is to be considered.
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21
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Successful cyclophosphamide therapy with complete resolution of pulmonary artery aneurysm in Hughes–Stovin syndrome patient. Clin Rheumatol 2008; 27:1455-8. [DOI: 10.1007/s10067-008-0951-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
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22
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Ketchum ES, Zamanian RT, Fleischmann D. CT Angiography of Pulmonary Artery Aneurysms in Hughes-Stovin Syndrome. AJR Am J Roentgenol 2005; 185:330-2. [PMID: 16037501 DOI: 10.2214/ajr.185.2.01850330] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eric S Ketchum
- Department of Radiology, Thoracic Imaging Section, Stanford University Medical Center, 300 Pasteur Dr., Rm. S-072, Stanford, CA 94305-5105, USA
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23
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Affiliation(s)
- Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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24
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Carette MF, Khalil A, Parrot A. Hémoptysies : principales étiologies et conduite à tenir. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcpn.2004.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alí-Munive A, Varón H, Maldonado D, Torres-Duque C. [Giant aneurysms of the pulmonary artery and peripheral venous thrombosis (Hughes-Stovin syndrome): regression with immunosuppressant therapy]. Arch Bronconeumol 2001; 37:508-10. [PMID: 11734141 DOI: 10.1016/s0300-2896(01)75131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the case of a young Afro-Caribbean patient who complained of dry cough and low-grade fever. A chest film upon admission showed bilateral hilar masses in the lungs, which a CT scan with contrast medium confirmed were giant aneurysms of the pulmonary artery. The most relevant past history was deep venous thrombosis six months before admission. Hughes-Stovin syndrome was diagnosed and treatment was started with prednisolone and azathioprine. A scan 6 months after treatment ended showed the aneurysms had disappeared. Hughes-Stovin syndrome is characterized by pulmonary artery aneurysms and peripheral deep venous thromboses. Severe lung complications can include hemoptysis and thromboses inside the aneurysms. Hughes-Stovin syndrome has been considered a variety of BehCet's disease.
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Weintraub JL, DeMayo R, Haskal ZJ, Susman J. SCVIR annual meeting film panel session: diagnosis and discussion of case 1: Hughes-Stovin syndrome. J Vasc Interv Radiol 2001; 12:531-4. [PMID: 11287545 DOI: 10.1016/s1051-0443(07)61897-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J L Weintraub
- Department of Radiology, New York Presbyterian Hospital/Columbia, MHB 4-100, 177 Fort Washington Ave., New York, NY 10032, USA.
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