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Gozzi L, Cozzi D, Zantonelli G, Giannessi C, Giovannelli S, Smorchkova O, Grazzini G, Bertelli E, Bindi A, Moroni C, Cavigli E, Miele V. Lung Involvement in Pulmonary Vasculitis: A Radiological Review. Diagnostics (Basel) 2024; 14:1416. [PMID: 39001306 PMCID: PMC11240918 DOI: 10.3390/diagnostics14131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
Pulmonary vasculitis identifies a heterogeneous group of diseases characterized by inflammation, damage and necrosis of the wall of pulmonary vessels. The most common approach to classify vasculitis is according to etiology, therefore dividing them into primary and secondary, with a further sub-classification of primary vasculitis based on the size of the affected vessels (large, medium, and small). Pulmonary involvement is frequently observed in patients with systemic vasculitis and radiological presentation is not pathognomonic, but may vary between diseases. The main findings using high-resolution computed tomography (HRCT) include small vessel wall thickening, nodular lesions, cavitary lesions, reticular opacities, ground-glass opacities (GGO), consolidations, interlobular septal thickening, tracheobronchial stenosis, and aneurysmal dilatation of pulmonary arteries, with or without pleural effusion. Radiological diagnosis alone is difficult since signs and symptoms of lung vessel involvement are often non-specific and might overlap with other conditions such as infections, connective tissue diseases and neoplasms. Therefore, the aim of this review is to describe the most common radiological features of lung involvement in pulmonary vasculitis so that, alongside detailed clinical history and laboratory tests, a prompt diagnosis can be performed.
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Affiliation(s)
- Luca Gozzi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Zantonelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Caterina Giannessi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Simona Giovannelli
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Olga Smorchkova
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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Emad Y, Ragab Y, Farber HW, Erkan D, Ibrahim O, Kindermann M, Tekavec-Trkanjec J, Jayakrishnan B, El-Shaarawy N, Kechida M, Young P, Pankl S, Fabi M, Bawaskar P, Kably I, Ghirardo S, Frikha F, Abou-Zeid A, Hassan M, Robinson C, Abdelbary MH, Tornes L, Margolesky J, Barman B, Bennji S, Agarwala MK, Alhusseiny K, Amezyane T, Silva RS, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Guffroy A, Kim JT, Ruffer N, Tharwat S, Cozzi D, Abdelali M, Joy TC, Sayed M, Sherwina J, Gheita T, Rasker JJ. Pulmonary embolism versus pulmonary vasculitis in Hughes-Stovin syndrome: Characteristic computed tomography pulmonary angiographic findings and diagnostic and therapeutic implications. HSS International Study Group. Thromb Res 2024; 239:109040. [PMID: 38795561 DOI: 10.1016/j.thromres.2024.109040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIM Hughes-Stovin syndrome (HSS) is a rare systemic vasculitis with widespread venous/arterial thrombosis and pulmonary vasculitis. Distinguishing between pulmonary embolism (PE) and in-situ thrombosis in the early stages of HSS is challenging. The aim of the study is to compare clinical, laboratory, and computed tomography pulmonary angiography (CTPA) characteristics in patients diagnosed with PE versus those with HSS. METHODS This retrospective study included 40 HSS patients with complete CTPA studies available, previously published by the HSS study group, and 50 patients diagnosed with PE from a single center. Demographics, clinical and laboratory findings, vascular thrombotic events, were compared between both groups. The CTPA findings were reviewed, with emphasis on the distribution, adherence to the mural wall, pulmonary infarction, ground glass opacification, and intra-alveolar hemorrhage. Pulmonary artery aneurysms (PAAs) in HSS were assessed and classified. RESULTS The mean age of HSS patients was 35 ± 12.3 years, in PE 58.4 ± 17 (p < 0.0001). Among PE 39(78 %) had co-morbidities, among HSS none. In contrast to PE, in HSS both major venous and arterial thrombotic events are seen.. Various patterns of PAAs were observed in the HSS group, which were entirely absent in PE. Parenchymal hemorrhage was also more frequent in HSS compared to PE (P < 0.001). CONCLUSION Major vascular thrombosis with arterial aneurysms formation are characteristic of HSS. PE typically appear loosely-adherent and mobile whereas "in-situ thrombosis" seen in HSS is tightly-adherent to the mural wall. Mural wall enhancement and PAAs are distinctive pulmonary findings in HSS. The latter findings have significant therapeutic ramifications.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Harrison W Farber
- Tufts University School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, MA, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Ashton Rd, Lancaster LA1 4RP, United Kingdom
| | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000 Zagreb, Croatia
| | | | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, 41522 Ismailia, Egypt
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, Monastir 5019, Tunisia
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair road, Mumbai 400008, Maharashtra, India
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127 Trieste, TS, Italy
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029 Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public health Department, Faculty of medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al kartoom square, al Azareta, Alexandria 21526, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of medicine, Helwan University, Egypt
| | - Leticia Tornes
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Jason Margolesky
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad 500096, India
| | - Khalid Alhusseiny
- Radiology department, Dr Erfan General hospital, Jeddah, Saudi Arabia
| | - Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, School of Medicine, Rabat, Morocco
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, 20231-092 Rio de Janeiro, RJ, Brazil
| | - Khalfan Al-Zeedy
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, Madrid 28222, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Izmir KatipÇelebi University Faculty of Medicine, Karabağlar, Izmir, Turkey
| | - Aurelien Guffroy
- Service d'immunologieclinique et médecine interne, centre de référence des maladies auto-immunes systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091 Strasbourg, France; UFR médecine Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Nikolas Ruffer
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Mabrouk Abdelali
- Department of Radiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Tubig C Joy
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Mona Sayed
- Nursing Medical Surgical Critical Care Department, Minia University, Minia, Egypt
| | - Juljani Sherwina
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Tamer Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands
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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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Joy TC, Sherwina J, Fernando A, Limpin ME, Mateo MP, Alhusseiny K. Pulmonary artery pseudoaneurysms (PAPs) in Hughes-Stovin syndrome (HSS) as an emerging concept for a potentially fatal course. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Manole S, Rancea R, Vulturar R, Simon SP, Molnar A, Damian L. Frail Silk: Is the Hughes-Stovin Syndrome a Behçet Syndrome Subtype with Aneurysm-Involved Gene Variants? Int J Mol Sci 2023; 24:ijms24043160. [PMID: 36834577 PMCID: PMC9968083 DOI: 10.3390/ijms24043160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Hughes-Stovin syndrome is a rare disease characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. The etiology and pathogenesis of HSS are incompletely known. The current consensus is that vasculitis underlies the pathogenic process, and pulmonary thrombosis follows arterial wall inflammation. As such, Hughes-Stovin syndrome may belong to the vascular cluster with lung involvement of Behçet syndrome, although oral aphtae, arthritis, and uveitis are rarely found. Behçet syndrome is a multifactorial polygenic disease with genetic, epigenetic, environmental, and mostly immunological contributors. The different Behçet syndrome phenotypes are presumably based upon different genetic determinants involving more than one pathogenic pathway. Hughes-Stovin syndrome may have common pathways with fibromuscular dysplasias and other diseases evolving with vascular aneurysms. We describe a Hughes-Stovin syndrome case fulfilling the Behçet syndrome criteria. A MYLK variant of unknown significance was detected, along with other heterozygous mutations in genes that may impact angiogenesis pathways. We discuss the possible involvement of these genetic findings, as well as other potential common determinants of Behçet/Hughes-Stovin syndrome and aneurysms in vascular Behçet syndrome. Recent advances in diagnostic techniques, including genetic testing, could help diagnose a specific Behçet syndrome subtype and other associated conditions to personalize the disease management.
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Affiliation(s)
- Simona Manole
- Department of Radiology, “Niculae Stăncioiu” Heart Institute, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
- Department of Radiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Raluca Rancea
- Cardiology Department, Heart Institute “Niculae Stăncioiu”, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
| | - Romana Vulturar
- Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy 6, Pasteur, 400349 Cluj-Napoca, Romania
- Cognitive Neuroscience Laboratory, University Babes-Bolyai, 30, Fântânele Street, 400294 Cluj-Napoca, Romania
- Correspondence:
| | - Siao-Pin Simon
- Department of Rheumatology, Emergency Clinical County Hospital Cluj, Centre for Rare Autoimmune and Autoinflammatory Diseases (ERN-ReCONNET), 2-4 Clinicilor Street, 400347 Cluj-Napoca, Romania
- Discipline of Rheumatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Adrian Molnar
- Department of Cardiovascular Surgery, Heart Institute “Niculae Stăncioiu”, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
- Department of Cardiovascular and Thoracic Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Laura Damian
- Department of Rheumatology, Emergency Clinical County Hospital Cluj, Centre for Rare Autoimmune and Autoinflammatory Diseases (ERN-ReCONNET), 2-4 Clinicilor Street, 400347 Cluj-Napoca, Romania
- CMI Reumatologie Dr. Damian, 6-8 Petru Maior Street, 400002 Cluj-Napoca, Romania
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Hughes-Stovin syndrome (HSS): current status and future perspectives. Clin Rheumatol 2021; 40:4787-4789. [PMID: 34655003 DOI: 10.1007/s10067-021-05958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
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Emad Y, Ragab Y, Robinson C, Pankl S, Young P, Fabi M, Bawaskar P, Ibrahim O, Erkan D, Barman B, Tekavec-Trkanjec J, Jayakrishnan B, Kindermann M, Kechida M, Guffroy A, Silva RS, Frikha F, Abou-Zeid A, Hassan M, Farber HW, Abdelbary MH, Tornes L, Margolesky J, El-Shaarawy N, Bennji S, Agarwala MK, Saad A, Amezyane T, Ghirardo S, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Kably I, Kim JT, Rasker JJ. Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide-a report by the HSS International Study Group. Clin Rheumatol 2021; 40:4993-5008. [PMID: 34533671 PMCID: PMC8599253 DOI: 10.1007/s10067-021-05912-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. Objectives The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. Methods The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image selection and approved by HSSISG board members. We classified these findings according to the clinical course of the patients. Results This atlas describes the CTPA images that best define the wide spectrum of pulmonary vasculitis observed in HSS. Pulmonary aneurysms were classified into six radiographic patterns: from true stable PAA with adherent in-situ thrombosis to unstable leaking PAA, BAA and/or PAP with loss of aneurysmal wall definition (most prone to rupture), also CTPA images demonstrating right ventricular strain and intracardiac thrombosis. Conclusion The HSSISG reference atlas is a guide for physicians regarding the CTPA radiological findings, essential for early diagnosis and management of HSS-related pulmonary vasculitis.
Key Points • The Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by extensive vascular thrombosis and pulmonary artery aneurysms (PAAs) that can lead to significant morbidity and mortality. • All fatalities reported in HSS were related to unpredictable massive hemoptysis; therefore, it is critical to recognize pulmonary complications at an early stage of the disease. • The HSS International Study Group reference atlas classifies pulmonary vasculitis in HSS at 6 different stages of the disease process and defines the different radiological patterns of pulmonary vasculitis notably pulmonary artery aneurysms, as detected by computed tomography pulmonary angiography (CTPA). • The main aim of the classification is to make a guide for physicians about this rare syndrome. Such a scheme has never been reached before since the first description of the syndrome by Hughes and Stovin since 1959. This classification will form the basis for future recommendations regarding diagnosis and treatment of this syndrome. |
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair Road, Mumbai, 400008, Maharashtra, India
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Ashton Rd., LancashireLancaster, LA1 4RP, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, 793018, Meghalaya, India
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary Medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000, Zagreb, Croatia
| | | | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken Des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, 5019, Monastir, Tunisia
| | - Aurelien Guffroy
- Service D'immunologieclinique et Médecine Interne, Centre de Référence des Maladies Auto-Immunes Systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091, Strasbourg, France.,UFR Médecine Strasbourg, Université de Strasbourg, 67000, Strasbourg, France
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029, Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public Health Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al Kartoom Square, Al Azareta, Alexandria, 21526, Egypt
| | - Harrison W Farber
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Leticia Tornes
- Department of Neurology, University of Miami Miller School of Medicine, Professional Arts Center, 1150 NW 14th St., Suite 609, Miami, FL, 33136, USA
| | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine, Professional Arts Center, 1150 NW 14th St., Suite 609, Miami, FL, 33136, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, Ismailia, 41522, Egypt
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital/Stellenbosch University, Francie van Zijl Drive Tygerberg 7505, Cape Town, South Africa
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500096, India
| | - Ahmed Saad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Taoufik Amezyane
- Department of Internal Medicine, School of Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, Rabat, Morocco
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127, Trieste, TS, Italy
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, Rio de Janeiro, RJ, 20231-092, Brazil
| | - Khalfan Al-Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, 123, Al-Khoud, Muscat, Oman
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, 28222, Madrid, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Faculty of Medicine, Izmir KatipÇelebi University, Karabağlar, Izmir, Turkey
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - 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
| | - 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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8
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Alba GA, Atri D, Darbha S, Singh I, Tapson VF, Lewis MI, Chun HJ, Yu YR, Maron BA, Rajagopal S. Chronic Thromboembolic Pulmonary Hypertension: the Bench. Curr Cardiol Rep 2021; 23:141. [PMID: 34410515 DOI: 10.1007/s11886-021-01572-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary embolism (PE), in which the red, platelet-rich thrombus does not resolve but forms into an organized yellow, fibrotic scar-like obstruction in the pulmonary vasculature. Here we review the pathobiology of CTEPH. RECENT FINDINGS Our current knowledge has predominantly been informed by studies of human samples and animal models that are inherently limited in their ability to recapitulate all aspects of the disease. These studies have identified alterations in platelet biology and inflammation in the formation of a scar-like thrombus that comprised endothelial cells, myofibroblasts, and immune cells, along with a small vessel pulmonary arterial hypertension-like vasculopathy. The development of CTEPH-specific therapies is currently hindered by a limited knowledge of its pathobiology. The development of new CTEPH medical therapies will require new insights into its pathobiology that bridge the gap from bench to bedside.
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Affiliation(s)
- George A Alba
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Deepak Atri
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sriranjani Darbha
- College of Natural Sciences, The University of Texas, Austin, TX, USA
| | - Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Victor F Tapson
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael I Lewis
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hyung J Chun
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Yen-Rei Yu
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Section of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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9
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Sravani N, Nagarajan K, Negi VS. Multiple Pulmonary Artery Aneurysms in Hughes-Stovin Syndrome. Arthritis Rheumatol 2021; 73:1737. [PMID: 33844455 DOI: 10.1002/art.41759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nichanametla Sravani
- Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Krishnan Nagarajan
- Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Veer S Negi
- Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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10
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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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