A giant pseudoaneurysm of coronary artery in a young patient with Behçet's disease

No Ordinary Coronary: A Case Series of Two Large Coronary Artery Aneuryms Found on Chest X-Ray

BACKGROUND

Post-procedural coronary aneurysms can have high morbidity and mortality. Although found more commonly on ultrasound or computed tomography imaging, if large enough, they may appear on chest x-ray studies.

CASE REPORTS

We present two cases of coronary artery aneurysm visible on chest x-ray study-one originating from a saphenous vein graft and the other a left anterior descending artery pseudoaneurysm 1 week post heart catheterization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important for emergency physicians to recognize abnormal chest x-ray studies and to look for post-procedural complications, such as coronary artery aneurysm. Coronary artery aneurysm can be a potentially life-threatening condition requiring prompt recognition and surgical consultation.

The pattern of cardiovascular manifestations in Egyptian Behçet’s patients and its relation to disease activity

Background

Behçet’s disease (BD) is also referred to as vascular BD when it frequently involves the heart and vessels. This study aimed to describe the cardiovascular manifestations in patients with BD and its correlation to disease activity. We conducted a cross-sectional study on 40 patients diagnosed with BD according to the International Criteria for Behçet’s Disease 2014. All the patients were subjected to detailed history taking, full clinical examination, lab investigations, resting electrocardiogram, trans-thoracic echocardiography, and carotid artery duplex for measuring intimal thickness, peripheral arterial and venous duplex, computed tomography pulmonary angiography, and full ophthalmological examination. Regarding the activity of the disease, it was assessed according to the score of Behçet’s Disease Current Activity Form (BDCAF).

Results

The most common cardiac manifestation was valvular lesion (67.5%) where the most frequently affected valve was the tricuspid valve (27.5%). Although 25% of patients had left ventricular diastolic dysfunction, only 5% had intracardiac masses. Approximately 52.5% of patients had vascular lesion (deep venous thrombosis 45%, arterial involvement 7.5% [as pulmonary artery thrombosis 5% and aneurysm 2.5%]). Increase in intima media thickness (IMT) was observed in 7.5% of patients, while 60% had abnormal lipid profiles. Hypercholesterolemia was the most common lipid abnormality (50%). BDCAF score range was 4–12, which was significantly correlated to multiple cardiovascular parameters as a mitral, tricuspid valve, and vascular venous involvement (p < 0.05), while not significantly correlated to lipid profile (p > 0.05).

Conclusion

Cardiovascular complications are frequent among patients with BD, even those who are asymptomatic; therefore, these complications must be screened for early detection and proper management.

Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet's disease: a population-based cohort study

OBJECTIVES

To investigate whether uveitis is a predictor of acute myocardial infarction (AMI) among patients with Behcet's disease (BD).

DESIGN

Retrospective cohort study.

SETTING

Patients with BD were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013.

PARTICIPANTS

Among the 6508 patients with BD, 2517 (38.7%) were in the uveitis group and 3991 were in the non-uveitis group.

PRIMARY AND SECONDARY OUTCOME MEASURES

Kaplan-Meier curves were generated to compare the cumulative hazard of AMI in the uveitis and non-uveitis groups. Multivariate Cox regression analysis was used to estimate the adjusted HRs and 95% CI of AMI, and was adjusted for age, gender, systemic comorbidities (eg, hypertension, diabetes, hyperlipidaemia, smoking) and clinical manifestation of BD (eg, oral ulcers, genital ulcers, skin lesions, arthritis and gastrointestinal involvement).

RESULTS

The mean age of the BD cohort was 38.1±15.1 years. Compared with non-uveitis patients, uveitis patients were significantly younger and male predominant. There was no significant difference between the two groups for most proportions of systemic comorbidities and clinical manifestations. The Kaplan-Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI compared with the non-uveitis group (p<0.0001). In the multivariable Cox regression after adjustment for confounding factors, patients with uveitis had a significantly higher risk of AMI (adjusted HR 1.87; 95% CI 1.52 to 2.29). Other significant risk factors for AMI were age, hypertension, smoking, and skin lesions.

CONCLUSIONS

Statistical analyses from the nationwide database demonstrated that uveitis is a potential predictor of AMI in patients with BD.

Treatment approach to coronary aneurysms: percutaneous or surgical?

We have recently read with great interest the article by Teng P et al. entitled “Giant right coronary artery aneurysm mimicking a right intra-ventricular mass: a case report”. We appreciate the authors for their reports describing the treatment of a giant right coronary aneurysm mimicking a right intra-ventricular mass. On the other hand, we believe that there are some major drawbacks that need to be addressed.