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Emad Y, Ragab Y, Cozzi D, Ibrahim O, Abdelrahman W, Abdelali M, Kechida M, Hassanin M, Tharwat S, Salah S, Elshaarawy N, Frikha F, Hassanein S, Young P, Pankl S, Barman B, Abou-Zeid A, Rasker J. Pulmonary vasculitis in Behçet's disease: reference atlas computed tomography pulmonary angiography (CTPA) findings and risk assessment-management proposal. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023026. [PMID: 37712377 PMCID: PMC10540716 DOI: 10.36141/svdld.v40i3.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIM Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behçet's disease (BD).The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. METHODS The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. RESULTS Deep venous thrombosis was observed in 31(73.8%) patients, arterial thrombosis in 13(31%), peripheral arterial aneurysms in 12(286%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8(19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13(31), true unstable PAAs in 11(26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7(16.7%), unstable PAPs in 17(40.5%), the latter were associated with perianeurysmal leaking in 26(61.9%) and bronchial indentation in 19(45.2%).In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). CONCLUSION Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictor of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt identification and aggressive treatment. PAPs are a more serious aneurysmal pattern than true PAAs because they are a contained rupture of a PA branch in the context of pulmonary vasculitis.
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Affiliation(s)
- Yasser Emad
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt..
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy..
| | - Ossama Ibrahim
- 4 Morecambe Bay University Hospitals Lancaster, Ashton Rd.,Lancashire Lancaster LA1 4RP, UK.
| | - Walaa Abdelrahman
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mabrouk Abdelali
- Radiology Department, FattoumaBourguiba University Hospital, University of Monastir, Ruedu 1er juin 1955, 5019 Monastir, Tunisia.
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, FattoumaBourguiba University Hospital, University of Monastir, Ruedu 1er juin 1955, 5019 Monastir, Tunisia.
| | - Manal Hassanin
- 7Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Facultyof Medicine, Mansoura University, Mansoura, Dakahlia,Egypt.
| | - Shaimaa Salah
- 7Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
| | - Nashwa Elshaarawy
- 9Rheumatology and Rehabilitation Department, Facultyof Medicine, Suez Canal University, Ismailia 4.5 Km theRing Road, Ismailia 41522, Egypt.
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029, Sfax, Tunisia..
| | - Sara Hassanein
- 11Radiology Department, Assiut University Hospitals, Assiut, Egypt.
| | - Pablo Young
- Servicio de Clinica Medica, Hospital Britanico de BuenosAires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Sonia Pankl
- Servicio de Clinica Medica, Hospital Britanico de BuenosAires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Bhupen Barman
- Department of General Medicine, North Eastern IndiraGandhi Regional Institute of Health and Medical Sciences(NEIGRIHMS), Mawdiangdiang, Shillong 793018,Meghalaya, India.
| | - Alaa Abou-Zeid
- Public Health Department, Faculty of Medicine, Cairo University, Kasr Al‑Ainy St., Cairo 11562, Egypt.
| | - Johannes Rasker
- 15Faculty of Behavioral, Management and Social Sciences,Department Psychology, Health and Technology,University of Twente, Drienerloolaan 5, 7522NB Enschede,The Netherlands.
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Tharwat S, ElAdle SS, Moshrif AH, Ismail F, El-Shereef R, Talaat EA, Hassanein S, Hisham Y, Gheita TA. Computed tomography pulmonary angiography (CTPA) in Behçet's disease patients: a remarkable gender gap and time to refine the treatment strategy. Clin Rheumatol 2021; 41:195-201. [PMID: 34767109 DOI: 10.1007/s10067-021-05991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the work was to delineate the computed tomography pulmonary angiography (CTPA) findings in Behçet's disease (BD) patients with and without chest manifestations. PATIENTS AND METHODS The study included 122 BD adults recruited from 5 Teaching University Hospitals in Egypt of those who agreed to perform a CTPA. The Arabic version of BD current activity form (BDCAF) and BD damage index (BDI) were assessed. Detailed pulmonary manifestations, examination, plain radiology chest, and CTPA findings were recorded. RESULTS The mean age of patients was 36.9 ± 11.3 years, male:female was 1.8:1, disease duration 9.6 ± 8.2 years, and age at onset 28.3 ± 8.6 years. Their mean BDCAF was 4.4 ± 2.2 and BDI 3.4 ± 1.8. There were chest manifestations in 51 (41.8%) and plain chest x-ray findings in 13 (10.7%) and CTPA findings in 31 (25.4%) in the form of pulmonary thromboembolism in 15 (12.3%), pulmonary aneurysms in 7 (5.7%), pneumonia in 5 (4.1%), interstitial lung disease in 4 (3.3%) and pleural effusion in 3 (2.5%). Patients with chest manifestations had significantly higher frequency of cardiac manifestations (15.7%) compared to those without (2.8%; p = 0.023); chest x-ray findings tended to be higher (17.6% vs 5.6%; p = 0.05) while CTPA findings were significantly detected (51% vs 7%; p < 0.0001). Higher frequency of CTPA findings were in females (p < 0.0001). Yet the rate of serious pulmonary embolisms, aneurysms, and thrombosis was exclusive in males. CONCLUSION Meticulous investigation of the chest manifestations is warranted in BD patients to undermine the actual magnitude of pulmonary impact. CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases. Key Points • Meticulous chest assessment is warranted in Behçet's disease patients to undermine the actual magnitude of pulmonary impact • CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases.
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Affiliation(s)
- Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Suzan S ElAdle
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Rawhya El-Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Esraa A Talaat
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Sara Hassanein
- Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assuit, Egypt
| | - Yousra Hisham
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Xie X, Li X, Yu F. Multiple bilateral pulmonary arterial aneurysms with massive thrombosis in inferior vena cava and hepatic vein. J Card Surg 2021; 36:1541-1542. [PMID: 33625728 DOI: 10.1111/jocs.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaojun Xie
- Department of Cardiovascular Surgery, The Affiliated Hospital Of Southwest Medical University, Luzhou, China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, The Affiliated Hospital Of Southwest Medical University, Luzhou, China
| | - Xin Li
- Department of Cardiovascular Surgery, The Affiliated Hospital Of Southwest Medical University, Luzhou, China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, The Affiliated Hospital Of Southwest Medical University, Luzhou, China
| | - Fengxu Yu
- Department of Cardiovascular Surgery, The Affiliated Hospital Of Southwest Medical University, Luzhou, China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, The Affiliated Hospital Of Southwest Medical University, Luzhou, China
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BaŞ İkİzoĞlu N, AtaĞ E, Ergenekon AP, Yilmaz YeĞİt C, GÖkdemİr Y, Erdem Eralp E, BÜge Öz A, Karadag B. An Adolescent Presented With Hemoptysis: Pulmonary Artery Aneurysm in Pediatric Behçet's Disease. Arch Rheumatol 2020; 35:283-286. [PMID: 32851380 PMCID: PMC7406172 DOI: 10.46497/archrheumatol.2020.7459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022] Open
Abstract
Behçet's disease (BD) is a rare autoimmune and chronic inflammatory vasculitis, characterized by relapsing episodes of oral aphthous and genital ulcers, skin lesions, ocular lesions and vascular involvement. Pulmonary artery involvement is rare in BD but it carries a high mortality risk. In this article, we report a 15-year-old male patient presented with a two-month history of hemoptysis, cough, fewer and weight loss. On physical examination, auscultation revealed decreased breath sounds at left lung base. Bronchoscopy showed narrowed left lower lobe bronchus due to the external compression. Computed tomography angiography revealed multiple bilateral pulmonary artery aneurysms. Pathergy test was positive and he was diagnosed with BD. BD should be considered in the differential diagnosis of childhood hemoptysis.
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Affiliation(s)
- Nilay BaŞ İkİzoĞlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Emine AtaĞ
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz YeĞİt
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin GÖkdemİr
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayşim BÜge Öz
- Department of Pathology, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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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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Farouk H. Behçet's disease, echocardiographers, and cardiac surgeons: together is better. Echocardiography 2014; 31:783-7. [PMID: 25041047 DOI: 10.1111/echo.12524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Behçet's disease is an inflammatory disorder of unknown etiology, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Many abnormal echocardiographic findings have been previously reported in patients with Behçet's disease. Some of these; namely, aortic root dilation, aortic valve regurgitation, intracardiac thrombi, and pulmonary artery aneurysm may precede other manifestations of the disease and occasionally require surgical intervention for proper management. Compared to patients without Behçet's disease, management of these complications in patients with the disease is challenging and requires different treatment strategies. If diagnosis of Behçet's disease is missed prior to surgical intervention, higher incidence of surgical failure, recurrence, and even higher postoperative mortality may occur. In this review, the author discusses these major cardiac complications of Behçet's disease.
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Affiliation(s)
- Heba Farouk
- Lecturer of Cardiovascular Medicine, Cairo University Hospital, Cairo, Egypt
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