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Ceruti H, van de Borne P, Mirica DC. Association of endomyocardial fibrosis and minor myocarditis sequelae with intracardiac thrombus and Ebstein like valvulopathy in a patient with Behçet disease: a case report. Eur Heart J Case Rep 2024; 8:ytad631. [PMID: 38173783 PMCID: PMC10762881 DOI: 10.1093/ehjcr/ytad631] [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: 07/24/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
Background Cardiac complications occur in 1-6% of cases of Behçet disease (BD) with intracardiac thrombus being the most frequent complication. Endomyocardial fibrosis, less common and occasionally associated with intracardiac thrombus, is reported in <20 case reports of BD, among which, three cases are described to mimic Ebstein disease based on echocardiography. We present the first case in the literature of a 34-year-old man with BD diagnosed with multiple cardiovascular complications, highlighting the challenging diagnosis and treatment of this pathology, especially regarding anticoagulation therapy. Case summary A 34-year-old man, diagnosed with BD, presented to the Emergency Room with haemoptysis. Computed tomography study of the thorax diagnosed pulmonary arterial aneurysm with multiple arterial thrombi, associated with multiple intracardiac thrombi in the right ventricle and atrium. The echocardiography confirmed the presence of voluminous thrombi in the right ventricle and atrium and showed hypertrabeculation of the right ventricle and a high insertion of the posterior leaflet of the tricuspid valve inducing a moderate tricuspid insufficiency compatible with an Ebstein disease. The cardiac MRI later revealed right ventricular fibrosis consistent with endomyocardial fibrosis and sequelae of myocarditis, also described as BD rare cardiac manifestations. The patient had a favourable outcome under anticoagulant treatment and immunosuppressive drugs. Discussion The association of multiple cardiovascular complications can occur in a single patient with BD. The endomyocardial fibrosis in the right heart chambers acting as a substrate for thrombus formation and subsequent pulmonary embolism; fibrosis extending to the tricuspid valve inducing an Ebstein-like morphology.
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Affiliation(s)
- Hélène Ceruti
- Department of Cardiology, Hopital Universitaire de Bruxelles (HUB), Route de Lennik, Hopital Erasme, Route de Lennik 808, 1070 Anderlecht, Bruxelles, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Hopital Universitaire de Bruxelles (HUB), Route de Lennik, Hopital Erasme, Route de Lennik 808, 1070 Anderlecht, Bruxelles, Belgium
| | - Daniela-Corina Mirica
- Department of Cardiology, Hopital Delta, Boulevard du Triomphe Hopital Delta, Boulevard du Triomphe 201, 1160 Auderghem, Bruxelles, Belgium
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van der Geest KS, Slijkhuis BG, Tomelleri A, Gheysens O, Jiemy WF, Piccolo C, Nienhuis P, Sandovici M, Brouwer E, Glaudemans AW, Mulder DJ, Slart RH. Positron Emission Tomography Imaging in Vasculitis. Cardiol Clin 2023; 41:251-265. [PMID: 37003681 DOI: 10.1016/j.ccl.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Systemic vasculitides comprise a group of autoimmune diseases affecting blood vessels. [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) plays an important role in the diagnosis and therapeutic monitoring of vasculitides affecting large-sized and medium-sized vessels. FDG-PET/CT also provides complementary information to other vascular imaging tools. The resolution and sensitivity of newer generation scanners continues to increase, hereby improving the ability of FDG-PET/CT to accurately assess the full disease extent in patients with vasculitis. Novel tracers targeting specific immune cells will allow for more detailed detection of vascular infiltrates.
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El Minaoui M, EL Houari A. A huge serpentine embolic intracardiac thrombus: A rare manifestation of Behcet's disease. Radiol Case Rep 2022; 17:4838-4841. [PMID: 36238216 PMCID: PMC9550529 DOI: 10.1016/j.radcr.2022.09.056] [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: 09/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Behcet's disease is a systemic vasculitis that can manifest as an intracardiac thrombus, which is rare but a serious complication. We report a case of a young male with a history of diabetes mellitus and erythema nodosum, who was admitted for pulmonary embolism associated with a huge serpentine right ventricle thrombus leading to the diagnosis of Behcet's disease. The patient was managed medically with a favorable evolution. The development of intracardiac thrombus is a life-threatening manifestation of the disease, and its discovery, especially in young subjects must suggest the diagnosis of Behcet's disease even if there is no predisposing ethnic or geographical factor.
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Abstract
Behçet syndrome (BS) is a unique type of vasculitis that affects veins and arteries of all sizes, leading to recurrent vascular events, mostly venous thrombosis. The prevalence of venous thromboembolism in BS patients ranges between 15 and 40%. Thrombosis is usually an early manifestation leading to diagnosis of BS in up to 40% of patients. BS is per se a model of inflammation-induced thrombosis. The primary autoimmune response activates lymphocytes that in turn produce a cytokine cascade that activates neutrophils, which modify the secondary structure of fibrinogen making it less susceptible to plasmin-induced lysis. This leads to endothelial dysfunction, platelet activation and overexpression of tissue factor leading to inflammatory thrombi, usually attached to the wall. The pathogenesis of thrombosis is especially relevant to direct the specific treatment, that is based on immunosuppression rather than anticoagulation. Superficial vein thrombosis (SVT) and deep vein thrombosis (DVT) are the most common form of thrombosis in BS, but thrombosis in atypical sites (cava vein, suprahepatic veins, intracardiac thrombus) and arterial involvement can also occur. We assessed the latest update of the European League Against Rheumatism recommendations for the management of BS. Vascular Behçet treatment is usually based of immunosuppressants, and the role of anticoagulation remains controversial. The use of interventional and surgical procedures should be carefully evaluated, due to the risk of triggering a vascular pathergy phenomenon.
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Ahmed AA, Tharwat S, Batouty NM, El Bahy A, Tawfik AM, Shahin DA. Cardiac magnetic resonance imaging in patients with Behçet's disease. Adv Rheumatol 2021; 61:74. [PMID: 34876236 DOI: 10.1186/s42358-021-00230-3] [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: 08/18/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behçet's disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients. METHODS This cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI. RESULTS At least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities. CONCLUSION BD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.
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Affiliation(s)
- Ali A Ahmed
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt.
| | - Nihal M Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed El Bahy
- Mansoura University Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed M Tawfik
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Dina A Shahin
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt
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Miqdad MA, Mohamad A, Ali F, Kawari M, Alboainain S. Intracardiac Thrombus Formation and Bilateral Pulmonary Embolisms in a Patient With Behcet's Disease While on Regular Infliximab Infusion: A Case Report. Cureus 2021; 13:e18592. [PMID: 34765357 PMCID: PMC8575333 DOI: 10.7759/cureus.18592] [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] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Vascular complications of Behcet'sdisease, including intracardiac thrombus formation, are one of the significant causes of mortality and morbidity in this population. Similar to other vasculitic disorders, Behcet's disease is primarily treated with immunosuppressants. While the benefit of adding anticoagulants in Behcet's disease with thromboembolism remains debatable, some literature encourages its use with concomitant intracardiac thrombus. Herewith, we present the case of a young male who was diagnosed with bilateral pulmonary embolism in addition to right ventricle intracardiac thrombus upon his scheduled dose of infliximab infusion. He was managed by adding azathioprine to his regimen together with oral prednisolone and warfarin with a target international normalized ratio of 2-3. This case report addresses the importance and outcome of early identification of Behcet's disease's vascular complications and immediate initiation of anticoagulation accordingly.
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Affiliation(s)
- Mohammed A Miqdad
- Department of Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU.,Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abdullah Mohamad
- Department of Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Fawaz Ali
- Department of Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Mohammed Kawari
- Department of Internal Medicine, Unit of Hematology, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Salha Alboainain
- Department of Rheumatology, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
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Pazzola G, Pipitone N, Salvarani C. Cardiac involvement in the adult primary vasculitides. Expert Rev Clin Immunol 2020; 16:985-991. [PMID: 32954889 DOI: 10.1080/1744666x.2021.1823219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Heart involvement in vasculitis is rare, but potentially severe. The ascertainment of cardiac disease in vasculitis is complex and requires an integrated multidisciplinary approach involving the Rheumatologist, Radiologist, Cardiologist, and Heart surgeon. AREAS COVERED the authors searched PubMed using the keywords 'heart'[Mesh] and vasculitis"[Mesh]. EXPERT OPINION Virtually any vasculitis can affect the heart, but cardiac involvement is more common in some vasculitides such as Takayasu arteritis, polyarteritis nodosa, and eosinophilic granulomatosis with polyangiitis. Immunosuppressive treatment and when indicated surgery can improve the prognosis.
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Affiliation(s)
- Giulia Pazzola
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia , Reggio Emilia, Italy
| | - Nicolò Pipitone
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia , Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia , Reggio Emilia, Italy
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8
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Soulaidopoulos S, Madenidou AV, Daoussis D, Melissaropoulos K, Mavrogeni S, Kitas G, Dimitroulas T. Cardiovascular Disease in the Systemic Vasculitides. Curr Vasc Pharmacol 2020; 18:463-472. [PMID: 32000652 DOI: 10.2174/1570161118666200130093432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
The vasculitides are a heterogeneous group of disorders, characterized by inflammatory cell infiltration and necrosis of blood vessels that cause vascular obstruction or aneurysm formation, affecting various organs such as lungs, kidneys, skin and joints. Cardiac involvement is commonly encountered in primary systemic vasculitis and it is associated with increased morbidity and mortality. Depending on the dominant pathophysiological mechanism, heart complications may manifest in different ways, including myocardial ischemia due to impaired micro- or macrovascular circulation, progressive heart failure following valvular heart disease and myocardial dysfunction, (sub) clinical myocarditis, pericarditis, pulmonary hypertension as well as arteritis of coronary vessels. Beyond cardioprotective regimens, aggressive immunosuppression reduces the inflammatory burden and modulates the progression of cardiovascular complications. Perioperative management of inflammation, when surgical treatment is indicated, improves surgical success rates and postoperative long-term prognosis. We aim to provide an overview of the pathogenetic, diagnostic and therapeutic principles of cardiovascular involvement disease in the various forms of systemic vasculitis.
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Affiliation(s)
- Stergios Soulaidopoulos
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | | | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, Faculty of Medicine, University of Patras Medical School, Patras, Greece
| | - Konstantinos Melissaropoulos
- Department of Rheumatology, Patras University Hospital, Faculty of Medicine, University of Patras Medical School, Patras, Greece
| | | | - George Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, United Kingdom
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Ramoğlu MG, Atalay S, Uçar T, Fitoz S, Özçakar ZB, Çiftçi E, Tutar E. Multiple intra-cardiac masses: A life-threatening complication of Behçet's disease. Echocardiography 2020; 37:1077-1079. [PMID: 32557850 DOI: 10.1111/echo.14771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 11/30/2022] Open
Abstract
The incidence of multiple intra-cardiac masses is rare, and the differential diagnosis may be challenging sometimes. The most common etiologies of multiple intra-cardiac masses are thrombus, vegetation, and tumors. Intra-cardiac thrombus is more common in patients with central catheters, with a wall-motion abnormality and global hypokinesis. Certain autoimmune disorders may favor the development of intra-cardiac thrombus, and very rarely, multiple thrombi may be seen. Here, a patient with multiple intra-cardiac masses in the right ventricle and diagnosed with Behçet's disease is presented.
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Affiliation(s)
- Mehmet Gökhan Ramoğlu
- Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Semra Atalay
- Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Tayfun Uçar
- Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Suat Fitoz
- Department of Pediatric Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Department of Pediatric Rheumatology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
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10
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Amchich Y, Reguig N, Boucaid A, Belghoule R, Zegmout A, Bourkadi JE. Intracardiac thrombus in Behçet's disease: a rare case in Morocco. Pan Afr Med J 2020; 36:92. [PMID: 32774651 PMCID: PMC7392863 DOI: 10.11604/pamj.2020.36.92.23741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
Behçet’s syndrome is a systemic inflammatory disease generally presented with the triad of uveitis, oral and genital ulcers. However, it may present with gastrointestinal, central nervous system, skin and vascular disease manifestations. Intracardiac thrombus is a rare but serious complication of Behçet’s disease. A 16-year-old man with Behçet’s syndrome was hospitalized into our department with a history of cough, fever, chest pain, hemoptysis, and weight loss. Transthoracic echocardiography and chest scan revealed a right ventricular thrombus. After one month of treatment with cyclophosphamide, and corticosteroid the intracardiac thrombus has been resolved.
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Affiliation(s)
- Younes Amchich
- Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Nezha Reguig
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | | | - Reda Belghoule
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | - Adil Zegmout
- Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
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11
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Is Immunosuppressive and Thrombolytic Therapy Really Effective in a Patient With Intracardiac Thrombosis and Pulmonary Artery Aneurysm due to Behçet's Disease? Arch Rheumatol 2020; 34:451-456. [PMID: 32010896 DOI: 10.5606/archrheumatol.2019.7169] [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: 09/08/2018] [Accepted: 02/23/2019] [Indexed: 11/21/2022] Open
Abstract
Behçet's disease (BD) is a rare, multisystemic, chronic vasculitic disorder with unknown etiology. Intracardiac thrombus formation and pulmonary artery aneurysm in BD are very rare. The treatment protocol in patients with vascular involvement, particularly those with pulmonary artery aneurysm accompanied by thrombosis, have not been clearly defined. In this article, we report an exceptional case, who had been treated unsuccessfully with a combination of anti-inflammatory/immunosuppressive therapy and thrombolytic agents, to discuss the poor prognosis of pulmonary artery aneurysm accompanying intracardiac thrombosis in juvenile BD.
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12
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Galeano-Valle F, Demelo-Rodriguez P, Álvarez-Sala-Walther L, Pinilla-Llorente B, Echenagusia-Boyra MJ, Rodriguez-Abella H, Del-Toro-Cervera J. Intracardiac thrombosis in Behçet's Disease successfully treated with immunosuppressive agents: A case of vascular pathergy phenomenon. Intractable Rare Dis Res 2018; 7:54-57. [PMID: 29552448 PMCID: PMC5849627 DOI: 10.5582/irdr.2018.01006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Behçet's Disease (BD) is a rare multi-systemic inflammatory disorder classified as a systemic vasculitis of unknown aetiology. Vascular involvement occurs in approximately 5-51.6% cases, affecting venous and arterial vessels. Cardiac involvement is rare in BD (6%). There have been published approximately 93 cases of BD associated with intracardiac thrombosis, with different treatments and courses. We present a case of a 35-year-old spanish male that, after a percutaneous pharmacomechanical thrombectomy with venous stent placement, developed high fever and extensive venous thrombosis despite anticoagulation including intracardiac thrombosis (ICT) in the right ventricle and pulmonary embolism that leaded to the diagnosis of BD. The patient was successfully treated with immunosuppressants, achieving the complete resolution of ICT. We hypotesize that the endovenous procedure could have acted as a trigger for the posterior acute attack of the disease, representing a 'vascular pathergy phenomenon'. Vascular BD has to be suspected in cases of thrombosis recurrence despite correct anticoagulation, and intense immunosuppressive treatment should be considered.
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Affiliation(s)
- Francisco Galeano-Valle
- Venous Thromboembolism Unit. Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
- Address correspondence to: Dr. Francisco Galeano-Valle, Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain. E-mail:
| | - Pablo Demelo-Rodriguez
- Venous Thromboembolism Unit. Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
| | - Luís Álvarez-Sala-Walther
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Blanca Pinilla-Llorente
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Hugo Rodriguez-Abella
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit. Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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13
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Imaging manifestations of Behcet's disease: Key considerations and major features. Eur J Radiol 2017; 98:214-225. [PMID: 29196115 DOI: 10.1016/j.ejrad.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/26/2017] [Accepted: 11/17/2017] [Indexed: 01/16/2023]
Abstract
Behcet's disease is an autoimmune disease most commonly seen in the Middle East. Although primarily known with painful oral and genital ulcers, it can lead to vasculitis. Therefore, several associated complications such as thrombotic syndromes, aneurysmal arterial disease may arise. In many cases, it might be difficult to make the diagnosis purely based on clinical grounds; however, imaging plays an important role for both diagnosis and assessment of the disease's complications. We provide a comprehensive review of the most notable imaging findings of Behcet's disease.
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14
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Alekberova ZS, Ovcharov PS, Lisitsyna TA, Volkov AV, Popkova TV. [Behçet's disease: Intracardiac thrombosis (a description of two cases and a review of literature)]. TERAPEVT ARKH 2017. [PMID: 28631704 DOI: 10.17116/terarkh201789579-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behçet's disease (BD) is systemic vasculitis of unknown etiology, which is more common in the countries located along the Great Silk Road. The disease is diagnosed if a patient has 4 key diagnostic signs: aphthous stomatitis, genital sores, and eye and skin lesions. Vascular diseases referred to as minor criteria for BD are characterized by the formation of aneurysms and thrombosis, predominantly in the venous bed. In venous disorders, a blood clot can form in any vessel, including caval, cerebral, pulmonary, and other veins. The paper describes two clinical cases of BD with intracardiac thrombosis. In one case, a 24-year-old male patient with a documented diagnosis of BD, echocardiography revealed a left ventricular spontaneous echo contrast phenomenon that disappeared due to immunosuppressive therapy. The other case was a 34-year-old female patient, in whom the diagnosis was based on the international disease criteria: aphthous stomatitis, skin lesions (pseudopustulosis, erythema nodosum), and genital sores. Computed tomographic angiography showed a 3.7×2.2-cm mass (thrombus) in the right atrium. In addition, blood clots were present in the hepatic and inferior vena cava. No abnormalities in the coagulation system were found in both cases.
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Affiliation(s)
- Z S Alekberova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - P S Ovcharov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T A Lisitsyna
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - A V Volkov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T V Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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15
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Wang H, Guo X, Tian Z, Liu Y, Wang Q, Li M, Zeng X, Fang Q. Intracardiac thrombus in patients with Behcet's disease: clinical correlates, imaging features, and outcome: a retrospective, single-center experience. Clin Rheumatol 2016; 35:2501-7. [PMID: 26753545 DOI: 10.1007/s10067-015-3161-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/17/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023]
Abstract
Intracardiac thrombus (ICT) is a rare but serious complication of Behcet's disease (BD). The study was to report the clinical characteristics, imaging features, treatment, and outcomes of BD patients with ICT in a single tertiary center. A series of 626 BD patients admitted to Peking Union Medical College hospital between April 2003 and April 2013 were reviewed. A total of 12 (1.9 %) BD patients with ICT were included. ICT was presenting manifestation of BD in 5 of the 12 patients (41.7 %) and occurred mostly in men (9/12, 75 %) younger than 40 years. Patients with ICT had more arterial (66.7 vs. 7.3 %, p < 0.001) and venous involvement (75.0 vs. 8.1 %, p < 0.001) compared to those without ICT. Right heart was the most frequent site of ICT (11/12, 91.7 %). Thrombus were hyperechogenic and immobile with a broad-based attachment on echocardiography in most cases (11/12, 91.7 %). Cardiac magnetic resonance (CMR) was performed in four patients. All thrombi showed isointense on T1-weighted image, while all but one were hypointense on T2-weighted image without delayed enhancement. Remission of ICT was associated with therapy of anticoagulant, corticosteroid, and immunosuppressant in most cases (10/12, 83.3 %). There was no death, and relapses of ICT occurred in only one patient after tapering of immunosuppressant during follow-up. A diagnosis of BD should be considered when a young male patient presents with a mass in the right-sided heart accompanied by vascular lesions. Medical therapy especially adequate immunosuppressants might be the first choice for BD patients with ICT.
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Affiliation(s)
- Hui Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China.
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
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Ingimarsdóttir IJ, Wikström G. An intracardial mass in a young Syrian refugee. BMJ Case Rep 2015; 2015:bcr-2015-210180. [PMID: 26150640 DOI: 10.1136/bcr-2015-210180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old previously healthy man presented with orogenital ulcerations, high fever, weight loss and leg thrombosis. Antibiotics were ineffective. His symptoms persisted and 3 years later he suffered from exertional dyspnoea. Inflammatory markers were elevated and all cultures were negative. CT of the thorax showed bilateral pulmonary embolism and a mass attached to the septum of the right ventricle, as well as an occluded vena cava inferior. Histology of the cardiac mass revealed a thrombus. The pulmonary embolisation progressed despite treatment with full-dose dalteparin. After being diagnosed with Behçet's disease, a multisystemic large-vessel vasculitis, and treated with high-dose prednisolone and cyclophosphamide, his ulcerations and his symptoms of dyspnoea disappeared.
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Affiliation(s)
| | - Gerhard Wikström
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
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