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Derbel A, Snoussi M, Ghribi M, Ben Hamad M, Damak C, Frikha F, Marzouk S, Bahloul Z. Recurrent intra-cardiac thrombosis: A rare manifestation of Behçet's disease. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:115-117. [PMID: 38697708 DOI: 10.1016/j.jdmv.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
Behçet's disease is a systemic vasculitis characterized by recurrent bipolar aphtosis and ophthalmic disorders. Cardiac involvement is rarely reported and could be associated to poor prognosis. Intracardiac thrombosis is exceptional and represents a therapeutic issue. We report the case of a young man admitted in internal medicine department for management of prolonged fever and recurrent mouth ulcers.
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Affiliation(s)
- Abir Derbel
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia.
| | - Mouna Snoussi
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Mariem Ghribi
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Mayeda Ben Hamad
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Chifa Damak
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Sameh Marzouk
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
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2
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Ezzahraoui R, Belharty N, Bourouhou Z, El Ouartassi H. Intracardiac Thrombosis: An Uncommon Manifestation of Behçet's Disease. Cureus 2023; 15:e44385. [PMID: 37779811 PMCID: PMC10540505 DOI: 10.7759/cureus.44385] [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] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Behçet's disease is a chronic multisystemic vasculitis of unknown etiology that evolves in relapses and remissions with a predominance of cutaneous and ocular lesions. It is more frequent in young adults, with a predominantly male population from the Mediterranean and Middle East. Cardiac involvement is rare (1 to 6%) but represents one of the most serious complications that can affect the three tunics of the heart. Cardiac thrombus is uncommon, its diagnosis relies mainly on echocardiography, and the development of the empirical treatment is based on immunosuppressive therapy and anticoagulation depending on the case. We report the case of a 21-year-old man admitted for a 2-month history of fever, loss of weight, and body condition in association with an intracardiac thrombus in the context of Behçet's disease. Intracardiac thrombus is a rare manifestation of Behçet's disease; the diagnosis must be made quickly in order to allow early management.
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Affiliation(s)
| | - Najlaa Belharty
- Cardiology B, Ibn Sina University Hospital Center, Rabat, MAR
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3
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Hammami AS, Jellazi M, Arfa S, Daada S, Ben Hamda K, Achour A, Ouali S. Getting to the <em>heart</em> of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series. Reumatismo 2021; 73:32-43. [PMID: 33874645 DOI: 10.4081/reumatismo.2021.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
The aim was to investigate the frequency and spectrum of cardiac involvement (CI) in patients with Behçet syndrome (BS) in the Tunisian context, and to assess the clinical and imaging features, treatment, and outcomes. We retrospectively retrieved the medical records of patients with CI among 220 BS patients admitted to the hospital internal medicine department between February 2006 and April 2019, who fulfilled the International Study Group diagnostic criteria for BS. Ten patients (8 men, 2 women) were eligible for the study. Mean age was 37.3 years. Three patients had 2 isolated episodes of cardiac BS. The different types of CI were coronary artery disease (5/10), intracardiac thrombus (4/10), pericarditis (1/10), myocarditis (1/10), and myocardial fibrosis (1/10). Five patients had associated vascular involvement (50%). Medical treatment was based on corticosteroids and colchicine in all patients (100%), anticoagulants in 8 (80%), and cyclophosphamide followed by azathioprine in 9 (90%). The clinical course was favorable in 9 patients; 1 patient died. CI remains an important feature of BS because of its association with increased risk of mortality and morbidity. Therefore, early screening and detection with imaging methods are paramount. Also, better cooperation between rheumatologists and cardiologists could improve outcomes.
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Affiliation(s)
- A S Hammami
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
| | - M Jellazi
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Arfa
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Daada
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - K Ben Hamda
- Department of Cardiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - A Achour
- Department of Radiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Ouali
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
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Gong M, Mao Y, Liu J. In-stent repeated thrombosis secondary to coronary artery aneurysms percutaneous coronary intervention in Behchet's Disease: A Case report. Clin Case Rep 2021; 9:2356-2359. [PMID: 33936694 PMCID: PMC8077335 DOI: 10.1002/ccr3.4034] [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: 12/26/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Coronary artery aneurysm (CAA) is a rare and poor prognostic manifestation of Behcet's disease (BD). Percutaneous treatment approaches frequently failed to ameliorate acute coronary system (ACS). Long-term follow-up is recommended as the prognosis of coronary involvement and the risk of further disease progression with percutaneous intervention in BD are unknown. long-term anticoagulant and antiaggregant therapies should be considered to prevent further thrombosis and/or embolism.
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Affiliation(s)
- Minglian Gong
- Department of CardiologyDalian The Fifth People's HospitalLiaoningChina
- Department of CardiologyBeijing Anzhen HospitalCapital Medical UniversityBeijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
| | - Yi Mao
- Department of CardiologyFuwai HospitalChinese Academy of Medical SciencePeking Union Medical CollegeNational Center for Cardiovascular DiseaseBeijingChina
| | - Jinghua Liu
- Department of CardiologyBeijing Anzhen HospitalCapital Medical UniversityBeijing Institute of Heart Lung and Blood Vessel DiseasesBeijingChina
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El-Ghobashy N, El-Garf K, Abdo M. Arterial aneurysms in Behçet’s disease patients: Frequency, clinical characteristics and long-term outcome. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ebrahimifar P, Shahabi J. Right ventricular thrombosis as a manifestation of Behçet's syndrome. ARYA ATHEROSCLEROSIS 2017; 13:91-94. [PMID: 29026416 PMCID: PMC5628857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behçet's disease (BD) is a rare condition with a classic triad of oral and genital ulceration and eye disease. Cardiovascular complication is a rare finding in BD. CASE REPORT In this report, we present a seventeen years old patient with a history of fever for 20 days, who developed a clot in right ventricle (RV). Cardiac magnetic resonance imaging (MRI) and echocardiography demonstrated a thrombosis in RV and a thoracic multi detector computed tomographic image showed pulmonary thromboembolism (PTE) in patient. The patient was administered with methylprednisolone, cyclophosphamide and anticoagulant. A regular follow-up was carried out. Two months later, the RV clot had disappeared on transthoracic echocardiography (TTE). CONCLUSION In BD, early cardiac MRI and echocardiography should be performed for the detection of cardiac involvement, and medical treatment is the first choice of treatment.
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Affiliation(s)
- Payam Ebrahimifar
- Cardiologist, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Payam Ebrahimifar,
| | - Javad Shahabi
- Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Hijazi EM, Ibdah RK, Rawashdeh SI, Saadeh AM, Al-Balas HI. Inhibition of SA Node at Supine Position in Right Atrial Thrombus Complicating Behçet's Disease - From Cardiac Surgical Point of View. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:412-6. [PMID: 27311379 PMCID: PMC4917071 DOI: 10.12659/ajcr.897998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Female, 27 Final Diagnosis: Right atrial thrombus compressing the sinoatrial node Symptoms: Dyspnea • cough and hemoptysis with supine bradycardia reaching 36/min and dizziness Medication: — Clinical Procedure: Cardiac surgical intervention removing the mechanical cause if conservative management failed can be done safely Specialty: Surgery
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Affiliation(s)
- Emad Mohamed Hijazi
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Rasheed Khaled Ibdah
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Sukina Ismael Rawashdeh
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Abdullah Mahmoud Saadeh
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology,, Irbid, Jordan
| | - Hamzeh Ibrahim Al-Balas
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
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Abstract
Pulmonary artery aneurysms (PAAs) are the most common type of pulmonary involvement in Behçet's disease. However, the relationships between clinical features and prognosis have not been sufficiently evaluated. This article describes the results of a comprehensive review, revealing that PAAs have a predilection for hemoptysis manifestations, increased dimensions, right lower lobar location, multiplicity and concurrent intramural thrombus formation. Surgical intervention was needed in one third of patients. Patients with massive hemoptysis and PAA rupture warranted emergency operations. Conservatively treated patients were prone to PAA progression; interventional embolization was associated with higher risks of recurrence and reintervention for PAAs; and surgically treated patients exhibited the highest mortality rates. In conclusion, PAAs in Behçet's disease are characterized by a predilection for hemoptysis manifestations, right lower lobar location, multiplicity, and concurrent intramural thrombus formation. Both the condition itself and the surgical operations it warrants are linked with high mortality due to PAA hemorrhage.
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Affiliation(s)
- Shi-Min Yuan
- Fujian Medical University, People's Republic of China
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Xing W, Swaminathan G, Appadorai DR, Sule AA. A rare case of behçet disease presenting with pyrexia of unknown origin, pulmonary embolism, and right ventricular thrombus. Int J Angiol 2014; 22:193-8. [PMID: 24436611 DOI: 10.1055/s-0033-1347906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Behçet disease is a systemic vasculitis characterized by recurrent oral and genital ulcers and uveitis. We describe a rare case of a 43-year-old woman with Behçet disease who was admitted for pyrexia of unknown origin, cough, dyspnea, and chest pain. Her computerized tomography scan revealed pulmonary embolism and right ventricular thrombus. She was treated with anticoagulation for pulmonary embolism and right ventricular thrombus. She was well during her last follow-up.
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Affiliation(s)
- Weili Xing
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Girider Swaminathan
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Dorai Raj Appadorai
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Ashish Anil Sule
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
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Malik AA, Halabi AM, Jamil G, Qureshi A. Rare manifestation of Behcet's syndrome: insight from multimodality cardiovascular imaging. BMJ Case Rep 2012; 2012:bcr-2012-007148. [PMID: 23045452 DOI: 10.1136/bcr-2012-007148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A young Jordanian man was hospitalised with fever of 2 months duration. Preadmission diagnostic assessment including CT thorax and abdomen were inconclusive. Right-sided pleuritic chest pain was present on admission. Pulmonary embolism was suspected on a ventilation/perfusion lung scan. Lower-extremity deep venous thrombosis was, however, absent. Echocardiogram to exclude a cardiac source of pulmonary embolism showed a right ventricle mass which was also present on retrospective review of prehospitalisation CT thorax. Tissue characterisation of this mass on cardiac MRI was not helpful. Empiric anticoagulation was started without reduction in size at 3 weeks. Due to ongoing diagnostic uncertainty, surgical resection was performed. Histopathology confirmed this mass to be a thrombus. With unabated fever, right ventricular thrombosis with pulmonary embolism and cutaneous and scrotal ulceration which evolved later in the hospital course, a diagnosis of Bechet's syndrome was considered and subsequently confirmed. Response to immunosuppressive therapy was prompt.
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Affiliation(s)
- Azhar Ali Malik
- Department of Internal Medicine, Tawam Hospital, Alian, AbuDhabi, UAE.
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11
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Owlia MB, Mehrpoor G. Behcet's Disease: New Concepts in Cardiovascular Involvements and Future Direction for Treatment. ISRN PHARMACOLOGY 2012; 2012:760484. [PMID: 22530146 PMCID: PMC3317002 DOI: 10.5402/2012/760484] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/15/2011] [Indexed: 01/02/2023]
Abstract
Behcet's disease (BD) is the only systemic vasculitis involving both arteries and vein in any sizes. It frequently encounters in rheumatology clinics. It has some major morbidities and even fatal outcomes in some cases. The aim of this paper is to analyze the main concepts on pathophysiology and treatment options in BD, focusing on cardiovascular aspects, thrombosis, and potential future treatment.
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Affiliation(s)
- M. B. Owlia
- Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - G. Mehrpoor
- Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Louali FE, Tamdy A, Soufiani A, Oukerraj L, Omari D, Bounjoum F, Mekouar F, Tazi-Mezalek Z, Bouhouch R, Zarzur J, Cherti M. Cardiac thrombosis as a manifestation of Behçet syndrome. Tex Heart Inst J 2010; 37:568-571. [PMID: 20978571 PMCID: PMC2953211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Herein, we report 3 cases of Behçet syndrome that were accompanied by intracardiac thrombus. The 1st patient was a 30-year-old man who presented with dyspnea; a right atrial thrombus was identified upon transthoracic echocardiography. The 2nd patient was a 52-year-old man who was admitted for dyspnea; transthoracic echocardiography revealed an echogenic mass in the right ventricle. The 3rd patient was a 23-year-old man who was hospitalized for hemoptysis; the diagnosis of pulmonary embolism was made, and right ventricular thrombosis was found.Because these patients had no hemodynamic compromise, medical management consisting of immunosuppressive and anticoagulative therapy was adopted. This treatment resulted in complete dissolution of the thrombi.
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Sonia H, Khaldoun BH, Sylvia M, Faouzi M, Habib G, Mohamed BF. Stenosis and aneurysm of coronary arteries in a patient with Behçet's Disease. Open Cardiovasc Med J 2008; 2:118-20. [PMID: 19430524 PMCID: PMC2627529 DOI: 10.2174/1874192400802010118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 11/20/2008] [Accepted: 11/24/2008] [Indexed: 12/14/2022] Open
Abstract
Coronary artery disease is extremely rare in patients with Behçet’s disease. We report the case of a patient with a history of Behçet’s disease who was admitted in our hospital with instable angina pectoris. The patient’s electrocardiogram was normal. Coronary angiography revealed aneurysm of the distal right coronary artery with a tight stenosis of the proximal part of the posterolateral branch. These two conditions were initially treated with immunosuppressive treatment. Three years later coronary angiography showed a total occlusion of the right coronary artery treated with medical therapy. More than fourteen cases of coronary involvement were reported in the literature but the etiopathogeny and the treatment are yet unknown
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Affiliation(s)
- Hammami Sonia
- Department of Internal Medicine, University Hospital "F. Bourguiba" Monastir (Tunisia).
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Chae EJ, Do KH, Seo JB, Park SH, Kang JW, Jang YM, Lee JS, Song JW, Song KS, Lee JH, Kim AY, Lim TH. Radiologic and clinical findings of Behçet disease: comprehensive review of multisystemic involvement. Radiographics 2008; 28:e31. [PMID: 18603663 DOI: 10.1148/rg.e31] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Behçet disease is a chronic, relapsing, systemic disorder of unknown etiology, characterized by recurrent oral and genital ulcers, uveitis, and other clinical manifestations in multiple organ systems. Although the diagnosis is made on the basis of the combination of typical clinical symptoms, radiologic findings of Behçet disease show characteristic features of its involvement in the gastrointestinal, neurologic, cardiovascular, and thoracic organ systems. In the gastrointestinal tract, Behçet disease may produce various types of ulcers in the esophagus, stomach, and small and large intestines, as well as deeply penetrating ulcerations in the ileocecal region, with frequently accompanying enteric fistulas. Neurologic involvement includes typical and atypical parenchymal neurobehcet disease, dural sinus thrombosis, cerebral arterial aneurysm, occlusion, dissection, and meningitis. Vascular involvement is divided into three subsets including venous occlusion, arterial occlusion, and arterial aneurysm. Cardiac manifestations include intracardiac thrombus, endomyocardial fibrosis, periaortic pseudoaneurysm, and rupture of the sinus of Valsalva. Manifestations of Behçet disease in the thorax include pulmonary arterial aneurysm, pulmonary arterial thromboembolism, thrombosis in the superior vena cava, pulmonary infarction, hemorrhage, and vasculitis of the pleura and pericardium. These various manifestations of Behçet disease respond to steroid treatment; however, one of the characteristics of Behçet disease is the high rate of complications and recurrence after surgery. Familiarity with its various radiologic and clinical characteristics is essential in making an accurate early diagnosis and for prompt treatment of patients with Behçet disease.
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Affiliation(s)
- Eun Jin Chae
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul 138-736, Korea
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Marc K, Iraqui G, Jniene A, Benamor J, Bourkadi JE. Thrombose intracardiaque et anévrysmes de l’artère pulmonaire au cours de la maladie de Behçet. Rev Mal Respir 2008; 25:69-72. [PMID: 18288054 DOI: 10.1016/s0761-8425(08)70469-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Marc
- Service de Pneumologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Morocco.
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Ohlenforst S, Mueller J, Rox JM, Oldenburg J, Pötzsch B. Recurrent intracardiac thrombosis as an unusual manifestation of inherited thrombophilia. Int J Cardiol 2007; 114:380-1. [PMID: 16635532 DOI: 10.1016/j.ijcard.2005.11.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 11/16/2005] [Indexed: 11/22/2022]
Abstract
Patients with inherited thrombophilia are at high risk for the development of venous thrombosis that manifests mainly as deep venous thrombosis of the legs and/or pulmonary embolism. We report spontaneous right-sided intracardiac thrombosis in a young man as an unusual manifestation of inherited thrombophilia. The diagnosis of thrombophilia was confirmed by demonstration of the prothrombin-G20210A-mutation in the homozygous state. A second spontaneous intracardiac thrombosis occurred 3 years after discontinuation of oral anticoagulant treatment. This indicates the high risk for recurrence in patients developing intracardiac thrombosis in the absence of an underlying cardiac disease and warrants long-term oral anticoagulant treatment.
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