Behçet's syndrome with aortic aneurysms

Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis

Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4-53.8) months, while four (57%) had clinical improvement after 11.8 (0.2-29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments.

Superior Vena Cava Syndrome in Behçet's Disease

Behget's disease was first defined by a Turkish dermatologist of the same name, as a trisymptom syndrome which manifested itself with aphthae in the mouth, genital exul cerations and iridocyclitis with hypopyon. 1 Later, some other features have been attributed to this syndrome, namely skin changes, joint involvement, obstruction of arteries or veins, and infection of sterile injection sites.2-16 Some other rare findings have been also noted in Behqet's disease. Aphthae, genital exulcerations, eye lesions and skin changes are the major lesions. If a patient has three of the major lesions or two major + two minor lesions; the disease is considered to be complete in his case. According to the information we now have, the basic pathological disorder in Behget's disease is vasculitis. Thrombosis in the great veins and arteries, and aneurysms, are frequently noted. The majority of the cases, when they first come to the doctor, suffer from superior vena cava obstruction.

Superior vena cava obstruction is usually diagnosed easily. This causes the appear ance of many collateral veins over the anterior chest wall, the dilation of neck veins, and the growth of edema of the chest, neck and face. In the majority of superior vena cava syndromes noted in the literature, malignancy is pinpointed as the cause, while, occa sionally, benign lesions are also winnowed out to be the culprit.27,31

The aim of this work was to present the review of the last fourteen years' etiology of the superior vena cava syndromes in our hospital, and to attempt to find out how many of them were caused by Behçet's disease. As a result, it was found that Behget's disease is the second cause of superior vena cava syndrome, after malignancy. It is known that Behçet's disease is most frequently diagnosed in Turkey, Japan and Greece, so perhaps this result is not surprising for Turkey. 7,26 What's more, it is also probable that Behçet's disease might be the underlying cause in most of the cases dubbed "due to unknown reasons." To ascertain this properly, a careful case history and complete physical examination are compulsory.

Surgical Treatment of Abdominal Aortic Aneurysm Due to Vasculo-Behqet's Disease

A thirty-two-year-old woman was operated on for abdominal aortic aneurysm due to vasculo-Behqet's disease. Her aortography showed an aneurysm of curious eggplant-like configuration. At operation, the aneurysm was found to be adhered to the surrounding organ with the severely thickened wall. The diseased aorta was replaced with Y-shaped Dacron graft. Three anastomosis sites were apart from the inflammation and were rolled up with the Teflon felt for reinforcement. Pathology of the diseased wall showed an infiltration of the inflammatory cells with the small-vessel vasculitis due to Behqet's disease. She has had an uneventful postoperative course with a tapering corticosteroid therapy.

Angiographic Findings of Great Vessel Involvement in Behçet's Disease

Behçet's disease (BD) is a systemic disorder and vasculitis is a common pathologic finding that may give clues in the understanding of the vascular involvement. During the period between 1968 and 1988, 30 patients with BD had vascular complications that were diagnosed by conventional venography (indud ing cavography) (in 15 patients prior to 1985) and then by computed tomography, digital subtraction angiography (DSA), and sonography in the remaining 15 patients for the last four years . The group included 13 patients with superior vena caval obstruction (SVCO), 3 with inferior vena caval obstruction (IVCO), 4 with both SVCO and IVCO, 2 with IVCO and hepatic veins obstruction (Budd-Chiari syndrome, BCS), 1 patient with SVCO, IVCO, and BCS, 1 with BCS, 1 with portal vein and IVCO, 4 patients pulmonary artery occlusion (1 of them also had pulmonary artery aneurysm), and finally, 1 patient with right illiac artery aneurysm. In many cases, classical clinical features of BD were not evident when great vessels were involved.

The authors concluded that DSA and sonography are the preferred method in demonstrating vascular complications of BD and that BD should be taken into consideration when a patient presents with a great vessel involvement due to unknown cause.

A Rare Vascular Complication of Behçet' s Disease: Peripheral Aneurysms: Case Reports

Six patients with peripheral aneurysms secondary to Behçet's disease are presented . These cases, together with the cases reported in the literature , indicate that peripheral aneurysms are an integral manifestation of Behçet's disease. A brief review of the syndrome is also included.

[The aneurysms of digestive system arteries: three cases]

The aneurysms of digestive arteries are a rare pathological entity, with a risk of rupture associated to a high mortality rate, often asymptomatic, then they are discovered incidentally during a exam for other diagnostic purposes. We report three cases of digestive aneurysms, one of celiac trunk, one of mesenteric artery on behçet disease, and one of splenic artery, which were treated surgically with success.

Recurrent aortic aneurysm due to Behcet's disease: a case report from China

In this report, we present a twenty-nine year old patient with a five-year history of Behcet's disease (BD), who developed an ascending aortic aneurysm. Chest enhanced computed tomography scanning demonstrated a saccular aneurysm of the ascending aorta, with a maximum diameter of 11 cm. The patient was administered with prednisone, thalidomide and anticoagulant. A regular follow up was carried out. The patient lived well with blood sedimentation and C-reactive protein in the normal range.

Massive gastrointestinal bleeding due to the rupture of arterial aneurysm in Behçet's disease: case report and literature review

Massive gastrointestinal bleeding is a very rare manifestation of gastrointestinal Behçet's disease, mainly from the gastrointestinal mucosal lesions. We report herein the case of a 50-year-old man with intestinal Behçet's disease who suffered massive hemorrhage from ruptured arterial aneurysm. Colonoscopy demonstrated large amount of fresh blood in the entire colon, but we were not able to localize bleeding focus anywhere in the colon. Angiography was performed and it revealed that a small aneurysm on the right ileocolic artery with apparent extravasation of contrast material. A guiding catheter was inserted to a right ileocolic artery and superselective arterial embolization using microcoils was successful. Following this procedure, the gastrointestinal bleeding gradually subsided and completely stopped within a few days. He is now treating with prednisolone and sulfasalazine without recurrent bleeding until now.

Pulmonary vasculitis in behcet disease: a cumulative analysis

STUDY OBJECTIVES

The aims of this study were to investigate the frequency of pulmonary problems in Behçet disease (BD), and to discuss lesser-known features of pulmonary BD such as clinical characteristics, analysis of prognosis, and evaluation of treatment options with respect to the previously published cases.

DESIGN

We conducted a comprehensive review of the literature to analyze cumulated data about pulmonary involvement in BD.

SETTING

We found 159 articles regarding pulmonary disease associated with BD in May 2003.

PATIENTS

The evaluation of these articles demonstrated 598 pulmonary problems in 585 cases.

RESULTS

Pulmonary artery aneurysms (PAAs) are the most common pulmonary lesion in BD, and these are almost always associated with hemoptysis. Seventy-eight percent of patients with aneurysms have concomitant extrapulmonary venous thrombi or thrombophlebitis. Other pulmonary problems are reported in BD, and these are principally related to vascular lesions and radiologic abnormalities.

CONCLUSIONS

Pulmonary vascular problems, either PAA or involvement of small-sized vessels, are the main pulmonary disorders in BD. Immunopathologic findings indicate that the underlying pathogenesis is pulmonary vasculitis, which may result in thrombosis, infarction, hemorrhage, and PAA formation. Patients with small nonspecific radiologic abnormalities should be followed up closely since early diagnosis of vascular lesions may be life-saving. Immunosuppression is the main therapy for the treatment of a vasculitis. It is important that pulmonary angiitis is not mistaken for pulmonary thromboembolic disease since fatalities have occurred in BD shortly after initiation of anticoagulation/thrombolytic treatment.

Bilateral subclavian arterial aneurysm and ruptured abdominal aorta pseudoaneurysm in Behçet's disease

Behçet's disease is characterized by recurrent ulcers of the mouth and genitalia and relapsing iritis. It is recognized as a chronic multisystem disease affecting the skin, mucous membranes, eye, joints, central nervous system, and blood vessels. About 8% of the patients with Behçet's disease have severe vascular complications such as arterial aneurysm and occlusion. In our patient, there was a massive, painful, pulsatile mass on the clavicle on the right side of neck. A left subclavian artery aneurysm mass was observed on the left apex on a chest X-ray. Through angiography, a lobular giant saccular aneurysm on the proximal side of the right subclavian artery, giant aneurysm on the left subclavian artery, and occlusion on the left subclavian-axillary artery were observed. We treated first the right and then the left subclavian arterial aneurysm with a two-stage operation. The aneurysms were resected and polytetrafluoroethylene (PTFE) graft interposition was performed. Control angiography was performed 6 months postoperatively. Both grafts were open and there was no anastomotic aneurysm. The patient was reoperated on for a ruptured abdominal aorta pseudoaneurysm 13 months after the first operation. The aortic defect was repaired using a Dacron patch.

Vascular thrombohemorrhagic disorders: hereditary and acquired

This review has summarized the more important diseases that may be accompanied by or lead to a disorder of hemostasis or thrombosis via alterations of the vasculature. It is to be stressed that the vascular component of hemostasis is often overlooked by clinicians caring for patients with disorders of hemostasis and thrombosis. It should be appreciated that the vasculature is intricately related to the coagulation protein system and to platelets when involved in thrombohemorrhagic diatheses. Although many vascular disorders may lead to hemorrhage or thrombosis, it must be appreciated that often it is impossible to discern between a primary vascular defect/damage and a defect that has been induced by platelet activation/dysfunction or procoagulant abnormalities.

Carotid artery pseudoaneurysm in Behcet's disease

We report a case of carotid artery pseudoaneurysm occurring in a patient with Behcet's disease for the purpose of discussing approach to this unusual complication of Behcet's disease.

Pseudoaneurysm formation in surgically treated Behçet's syndrome--a case report

Behçet's syndrome is a multisystem disorder with unknown etiology. Clinically it is mostly seen as a systemic vasculitis; almost 30% of the patients have vascular involvements, and most of these are venous thrombosis and arterial aneurysms. Obstructions of the femoral and tibial arteries have also been reported in the literature. The authors present here a patient with Behçet's syndrome who had pseudoaneurysms on both femoral arteries after aortobifemoral bypass surgery.

Behçet's disease and complex aphthosis

Behçet's disease is a complex multisystem disease diagnosed by means of clinical criteria. Clinical features include oral and genital aphthae, pustular vasculitic cutaneous lesions, and ocular, gastrointestinal, and vascular manifestations. We believe that complex aphthosis, characterized by oral or oral and genital ulcers, may be a forme fruste of Behçet's disease. Although the pathogenesis of both Behçet's disease and complex aphthosis remain unknown, immune factors, infectious agents, and effector mechanisms are implicated. Treatment is based on the severity of systemic involvement and includes topical therapies as well as colchicine, dapsone, thalidomide, and immunosuppressive agents.

Arterial thrombosis leading to intestinal infarction in a patient with Behçet's disease associated with protein C deficiency

Behçet's disease may be a possible cause of both occlusive and aneurysmal arterial involvement as well as recurrent venous thrombosis. A case of Behçet's disease complicated with vascular involvement leading to intestinal infarction is presented. A 41-yr-old man suffering from Behçet's disease for 15 yr presented with a 2-day history of severe abdominal pain and bloody diarrhea. Intestinal infarction secondary to thrombosis of the superior mesenteric artery had been diagnosed during surgical exploration 3 yr previously. He was started on anticoagulation with nutritional support. The patient was readmitted with severe diarrhea and malabsorption symptoms 3 yr after intestinal resection. A thrombus located in the posterior wall of the infrarenal portion of aorta was detected by aortography and ultrasonography. Although thrombosis is a relatively common complication of Behçet's disease caused by vasculitis, protein C deficiency, which is a pertinent laboratory finding in this case, might be a secondary factor in the thrombotic event. This is the first case reported of mesenteric artery thrombosis leading to bowel infarction and abdominal aorta thrombosis associated with protein C deficiency.

Bilateral pulmonary artery aneurysms in a patient with Behcet syndrome: evaluation with radionuclide angiography and V/Q lung scanning

The case of a 14-year-old girl with Behcet syndrome is described. Besides painful and recurrent oral ulcerations, the patient had a cough and intermittent hemoptysis. The initial chest roentgenogram revealed bilateral parahilar opacities. CT and MRI scans of the thorax showed bilateral thrombosing aneurysms of the pulmonary arteries. Pulmonary blood flow imaging was performed after technegas ventilation lung scanning and Tc-99m MAA injection using a first-pass radionuclide angiography procedure. Altered blood flow in the left pulmonary artery was shown. Bilateral and well-defined ventilation/perfusion mismatched areas suggested a high probability of pulmonary embolism. Little additional information was obtained on subsequent contrast pulmonary angiography. The high incidence of pulmonary artery hypertension and associated vascular injury risk makes pulmonary angiography an unsafe procedure in patients with pulmonary Behcet syndrome. The need for pulmonary angiography could be obviated in such cases with the use of high-precision MRI and ventilation/perfusion lung scanning, including radionuclide pulmonary angiography.

Nonneoplastic diseases of aorta and pulmonary trunk--Part III

The five-part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more disease affect the aorta compared with the pulmonary trunk and right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part III of this five-part series discusses the etiology of aortic aneurysms and aortitis.

A fatal case of Behçet's disease associated with multiple cardiovascular lesions

Behçet's disease is recognised as a chronic multisystem disorder with vasculitis as its underlying pathological process. Cardiac involvement is rare and often associated with poor prognosis. A large right atrial thrombus, pulmonary aneurysms and aortic pseudoaneurysm that developed 17 years after surgery for bilateral renal artery stenosis is presented in a 26-year-old Behçet's disease patient. He was admitted to the hospital with fever of unknown origin associated with chest pain, dyspnea, cough, haemoptysis and pulmonary opacity in chest X-ray. Initial pulmonary CT demonstrated small subpleural infiltrates bilaterally, one of which was round and suspected as being metastatic. Examination of open lung biopsy demonstrated haemorrhagic infarct surrounded by some occluded pulmonary arteries. Subsequent CT showed pulmonary aneurysms compatible with Behçet's disease. Echocardiography demonstrated a large pedunculated mass in the right atrium. Injection of urographin showed a right atrial mass and a large right pulmonary artery aneurysm. The atrial mass was completely excised during open heart surgery and was identified as being an organising thrombus. Eight weeks later while taking prednisone, he was readmitted because of an infected mid sternal wound. CT showed slight separation of the stemum, retrosternal fluid, pulmonary arteries aneurysm and ascending aorta aneurysm. The next day, the patient died from massive bleeding from his ruptured ascending aortic pseudoaneurysm. Bizarre presentation of arterial and venous thromboses or arterial aneurysm formation, particularly in young patients, should suggest Behçet's disease.

Management of aneurysms in Behçet's syndrome: an analysis of 24 patients

BACKGROUND

The surgical therapy of Behçet aneurysms is often unsuccessful, resulting in graft occlusions, anastomoses, and/or new aneurysms.

METHODS

Twenty-nine aneurysms were documented in 24 Behçet's patients during a period of 19 years. All patients were male, ranging in age from 20 to 53 years (mean, 35 +/- 7.3 years). The mean duration of disease was 9 +/- 5 years. There were nine abdominal aorta, four iliac, three common femoral, five superficial femoral, four popliteal, one subclavian, one carotid, and one posterior tibial artery aneurysm. In addition, in one patient an aneurysm developed from the arterialized venous conduit that had been inserted for a common femoral artery aneurysm elsewhere. Five patients were already under immunosuppressive therapy for ocular problems at the time of diagnosis. Fifteen patients received immunosuppressive therapy after operation. We performed one abdominal aneurysmorrhaphy, two iliac artery PTFE graft interpositions, two aortobiliac bypasses (PTFE), six aortic tube graft (three PTFE, three Dacron) interpositions, one avrtofemoral bypass (PTFE), two iliofemoral bypasses (PTFE), two superficial femoral artery graft (PTFE) interpositions, and three popliteal graft interpositions (one PTFE, two vein graft). Also as an initial procedure one carotid, one subclavian, four superficial femoral, one popliteal, and one posterior tibial artery were ligated.

RESULTS

Nineteen patients were followed up for a mean duration of 47.3 +/- 27 months (range, 1 to 108 months). The patient with a subclavian aneurysm died of massive bleeding on postoperative day 15. Four patients were lost to follow-up. In the abdominal aortic aneurysm group one patient died of gastrointestinal bleeding 4 years after the operation. Another patient from the same group died 5 years after operation without any vascular disease. In the common femoral artery group the patient with an occluded iliofemoral graft died of an exsanguinating pulmonary artery aneurysm in the first year after operation. Overall, there were five anastomotic aneurysms. In addition, after the initial operation two iliofemoral, one aortofemoral, and one popliteal interposition graft were occluded without disabling ischemia.

CONCLUSIONS

Aneurysms limited to the extremities could be ligated without disabling ischemia. Abdominal aortic aneurysms could be treated with tube graft insertion, giving satisfactory results. Patients could tolerate graft occlusion without major ischemia.

A case of Behçet's disease with an abdominal aortic aneurysm and two aneurysms in the common carotid artery. A case report

A sixteen-year-old boy presented with varied symptoms to the hospital. After he had been diagnosed as having Behçet's disease, investigations revealed two carotid aneurysms in the right common carotid artery and one abdominal aortic aneurysm. The aneurysms were resected, medical therapy was started, and the patient recovered well. Although multiple aneurysms have been reported previously, the authors believe this is the first reported case involving both the carotid and the aorta.

Superior mesenteric artery aneurysm in Behçet's disease

Behçet's disease is a multisystem disorder characterized by recurrent orogenital ulcerations and uveitis. Vascular involvement can include both arteries and veins, with a preponderance of venous lesions. Aneurysms of splanchnic arteries due to Behçet's disease have been rarely reported. We present an unusual case of superior mesenteric artery aneurysm due to Behçet's disease diagnosed by ultrasonography and angiography.

Case report: intestinal infarction after an aneurysmal occlusion of superior mesenteric artery in a patient with Behçet's disease

A patient with Behçet's disease, accompanied by a large aneurysm of superior mesenteric artery, developed an ischemic enteritis with multiple perforated ulcers. The ischemic necrosis of the intestine preceded by recurrent abdominal pain was due to an aneurysmal occlusion of superior mesenteric artery, but not entero-Behçet's disease. This is the first case report of intestinal infarction that occurred in a patient with vasculo-Behçet's disease involving the superior mesenteric artery. Vasculo-Behçet's disease should be included in a differential diagnosis of acute mesenteric artery thrombosis.

Cutaneous fibrinolytic potential, tPA dependent, is reduced in Behçet's disease

We report our studies on the cutaneous and plasma fibrinolytic activities (FA) in nine patients with Behçet's disease (BD) as compared with nine normal controls. The euglobulin lysis time of the plasma and cutaneous fibrinolytic activity were determined in these patients. The studies showed that the plasma fibrinolytic activity was reduced in the patients with BD and there was impaired cutaneous fibrinolytic potential, tPA dependent, in those patients with venous and arterial thromboses.

Pulmonary manifestations in Behçet's syndrome

Among 72 patients with Behçet's syndrome, seven had pulmonary vascular involvement. Additional data from 42 cases in the literature are discussed. Recurrent episodes of dyspnea, cough, chest pain, and hemoptysis were the primary clinical signs, mainly in young men, appearing 3.6 years after the first manifestation of Behçet's syndrome. Fever, elevated ESR, and anemia were common, and chest x-ray films showed pulmonary infiltrates, pleural effusions, and prominent pulmonary arteries. Ventilation-perfusion scans showed perfusion defects even when chest x-ray films were normal. Pulmonary artery aneurysms were seen in 7/13 in whom angiography was done. Of 42 patients, 16 died, 15 from fatal pulmonary hemorrhage, 80 percent within two years from the development of pulmonary disease. Histopathologic study results showed vasculitis of pulmonary vessels of various sizes, leading to thrombosis, destruction of the elastic laminae, aneurysms, and arteriobronchial fistula. In addition, pulmonary emboli and the aphthous lesion of the tracheobronchial tree may aid the clinical picture. Anticoagulant therapy may be hazardous in patients with aneurysmal dilatation of the pulmonary vascular tree, and the beneficial effect of corticosteroid therapy is discussed. Pulmonary vasculitis in Behçet's syndrome is a unique clinical and pathologic picture, differing from other vasculitides affecting the lung, presents a major threat to the patient's life.

Abdominal aortic aneurysm with inferior vena cava obstruction: case report

Behçet's syndrome, a multisystem disorder, is characterized by recurrent oral and genital aphthous ulcerations, eye lesions, and skin changes. Other manifestations, although rare, may affect the nervous, gastrointestinal, or locomotor system, as well as veins and arteries. Vascular lesions occur in approximately 30% of reported cases. Although thrombosis in the larger veins is frequent, arterial thrombosis is somewhat less likely to occur. Only a few cases of arterial aneurysm have been documented in the literature. This report describes a patient who had suffered from Behçet's syndrome for fifteen years and in whom a complete obstruction of the inferior vena cava was demonstrated. An aortoiliac bypass was performed successfully, and the patient had had a good clinical recovery at long-term follow-up.

Pacemaker implantation in a patient with a Behçet's disease associated with superior vena cava obstruction

A 65-year-old man with Behçet's disease developed transient complete A-V block with syncope. An attempt to implant a permanent transvenous endocardial electrode failed owing to obstructions in the subclavian, innominate, and superior vena cava veins demonstrated by angiography. Sutureless epicardial electrodes were successfully implanted through a subxyphoid approach. Obstruction in the great veins is a common feature in patients with Behçet's disease. We suggest that patients with this disorder, who require a permanent pacemaker, should be investigated by angiography prior to implant to rule out obstruction in the upper great veins.

Iliac artery aneurysm in Behçet's disease: a case report

Today, Behcet's disease is known as a multisystem disorder. Eye lesions, mouth and genital aphthous lesions, and skin lesions are accepted as major lesions. The disease also attacks the locomotor system, central nervous system, gastrointestinal system and also arteries and veins. According to available data, some 30% of the patients have vascular lesions; mostly thrombosis of the veins. Arterial thromboses have been rarely reported; and only a few number of arterial aneurysms are noted. Here we present an iliac artery aneurysm in a case of Behcet's disease.

Nuclear magnetic resonance imaging in the assessment of unusual abdominal aortic aneurysms

Ultrasound and computed tomography (CT) have become primary methods of evaluating patients with abdominal aortic aneurysms. Arteriography may be necessary for further assessment. We have recently investigated two patients with complicated abdominal aortic aneurysms, one patient with Marfan's syndrome and the other with Behcet's disease. The initial diagnosis in both cases was made by ultrasound, but CT was inconclusive and aortography was contraindicated in both patients. Nuclear magnetic resonance (NMR) imaging was performed to see if further information could be obtained. This technique was useful in both cases, with elegant demonstration of the anatomy.

Chronic active hepatitis and Behçet's syndrome

In a patient with Behcet's syndrome the finding of five times the normal level of serum transaminase accompanied by weakness may be correlated to the syndrome itself. We performed needle biopsy of the liver in our patient which showed piecemeal necrosis and portal lympho-monocytic infiltration extending into the lobule. It is interesting that HLA B5 and B27 antigens were present. Simultaneous occurrence of chronic active hepatitis and Behcet's syndrome may imply the same autoimmune pathogenesis, as we suggest in this work.

Fetal arterial involvement in Behcet's disease: an electron microscope study

A fetus, 16 weeks old, was removed by hysterotomy from a patient suffering from Behcet's disease. The patient received systemic steroids during pregnancy. Electron microscopy of the fetal thoracic aorta revealed edema of the sub-endothelial space and of the luminal part of the tunica media, as well as a pronounced rarefaction and disarrangement of the smooth-muscle cells. Results obtained from two human fetal aortae used as controls suggest that the fetal aortic lesions were caused by the maternal disease and not by the exposure to steroids.

Behçet's disease

Behçet's disease is characterized by three primary components: iridocyclitis (historically with hypopyon), aphthous lesions in the mouth, and ulceration of the genitalia. Erythema nodosum, arthropathy and thrombophlebitis often accompany these manifestations, but the ocular symptoms may be the most important and serious manifestations of the disease. Central nervous system involvement, most often due to necrotizing vasculitis, may be the most protean manifestation of the disease, leading to death. The frequency of ocular manifestations is 70-85% in patients with the disease; the underlying disease mechanism in all organ systems is an occlusive vasculitis. Although the most common ocular symptom is that of anterior uveitis, often with hypopyon as a very late sign, the presence of necrotizing retinal vascular lesions is well known and often obscured by the severity of the anterior reaction. Definitions, incidence, clinical characteristics, differential diagnosis, and management of Behçet's ocular disease are discussed, as are the interrelationships of the different organ manifestations. The ophthalmologist should be familiar with the full spectrum of disease presentation since he or she may be the first physician to encounter the Behçet's patient.

Behçet's disease with endocarditis and the Budd-Chiari syndrome

Endocarditis of the mitral and aortic valves is described for the first time in a patient with Behçet's disease. A second patient had minor changes in the mitral valve similar to that seen in the vasculitis which occurs in this condition. Valvulitis in Behçet's disease probably has the same pathogenesis as the vasculitis. The second patient also had a rare combination of Behçet's disease and the Budd-Chiari syndrome, and the necropsy findings are described.

Aortic regurgitation and false aortic aneurysm formation in Behçet's disease

Behçet's disease is associated with vascular complications. Aortic regurgitation associated with this condition has never previously been described. A case is now reported in which this occurred and which was followed postoperatively by a false aneurysm of the ascending aorta.

Behçet's disease with arterial and renal manifestations

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A case of Behçet's disease involving the bladder

A case of Behçet's disease involving the bladder has been described. It resembled a bladder carcinoma. The pathology, aetiology and treatment have been briefly outlined.